Clinical Procedures for Medical Assistants 9th Edition Bonewit Test Bank

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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:

  1. Chapter 1 The Medical Record
  2. Key Terms
  3. Introduction to the Medical Record
  4. Components of the Medical Record
  5. Medical Office Administrative Documents
  6. Patient Registration Record
  7. Demographic Information
  8. Billing Information
  9. NPP Acknowledgment Form
  10. Correspondence
  11. Highlight on the HIPAA Privacy Rule
  12. What Is the HIPAA Privacy Rule?
  13. What Is Included in the HIPAA Privacy Rule?
  14. What if a Medical Office Does Not Comply With the HIPAA Privacy Rule?
  15. Where Can More Information on the HIPAA Privacy Rule Be Found?
  16. Medical Office Clinical Documents
  17. Health History Report
  18. Figure 1-1 Patient registration record.
  19. What Would You Do? What Would You Not Do?
  20. Case Study 1
  21. Categories of Medical Record Documents
  22. Medical Office Administrative Documents
  23. Medical Office Clinical Documents
  24. Laboratory Documents
  25. Diagnostic Procedure Documents
  26. Therapeutic Service Documents
  27. Hospital Documents
  28. Consent Documents
  29. Putting It All Into Practice
  30. Physical Examination Report
  31. Progress Notes
  32. Medication Record
  33. Prescription and Over-the-Counter Medication Record Form
  34. Medication Administration Record Form
  35. Figure 1-2 Medication record.
  36. Consultation Report
  37. Home Health Care Report
  38. Laboratory Documents
  39. Hematology
  40. Clinical Chemistry
  41. Immunology
  42. Urinalysis
  43. Microbiology
  44. Parasitology
  45. Cytology
  46. Histology
  47. Figure 1-3 Consultation report.
  48. Figure 1-4 Home health care report.
  49. Diagnostic Procedure Documents
  50. Electrocardiogram Report
  51. Holter Monitor Report
  52. Sigmoidoscopy Report
  53. Colonoscopy Report
  54. Spirometry Report
  55. Radiology Report
  56. Figure 1-5 Radiology report.
  57. Diagnostic Imaging Report
  58. Therapeutic Service Documents
  59. Physical Therapy
  60. Occupational Therapy
  61. Speech Therapy
  62. Hospital Documents
  63. Figure 1-6 Diagnostic imaging (CT scan) report.
  64. History and Physical Report
  65. Figure 1-7 Physical therapy report.
  66. Figure 1-8 Hospital history and physical examination report.
  67. Operative Report
  68. Figure 1-9 Operative report.
  69. Discharge Summary Report
  70. Pathology Report
  71. Figure 1-10 Discharge summary report.
  72. Emergency Department Report
  73. Figure 1-11 Pathology report.
  74. Figure 1-12 Emergency department report.
  75. Consent Documents
  76. Consent to Treatment Form
  77. Figure 1-13 Consent to treatment form.
  78. Release of Medical Information Form
  79. Mailed or Faxed Requests for Release of Medical Information
  80. Figure 1-14 Release of medical information form.
  81. Procedure 1-1 Completion of a Consent to Treatment Form
  82. Outcome
  83. Equipment/Supplies:
  84. Ask the patient to read the consent form.
  85. Ask the patient to sign the consent form.
  86.  Procedure 1-2 Release of Medical Information
  87. Outcome
  88. Equipment/Supplies:
  89. Witness the patient’s signature.
  90. Mailed or Faxed Requests for Release of Medical Information
  91. Types of Medical Records
  92. Electronic Medical Record
  93. Advantages of the Electronic Medical Record
  94. Figure 1-15 The computer can retrieve documents from a patient’s EMR very quickly.
  95. Disadvantages of the Electronic Medical Record
  96. Figure 1-16 Medical assistant taking patient symptoms using a computer and an electronic medical record program.
  97. Medical Assistants’ Use of the EMR
  98. Functions Performed by the Medical Assistant
  99. Physicians’ Use of the EMR
  100. Figure 1-17 Electronic medical record screen.
  101. Figure 1-18 Electronic medical record screen.
  102. Medical Record Formats
  103. Source-Oriented Record
  104. What Would You Do? What Would You Not Do?
  105. Case Study 2
  106. Problem-Oriented Record
  107. Database
  108. Figure 1-19 Chart dividers in a source-oriented record.
  109. Problem List
  110. Plan
  111. Figure 1-20 POR problem list.
  112. Figure 1-21 POR SOAP progress notes.
  113. Progress Notes
  114. Preparing a Medical Record for a New Patient
  115.  Procedure 1-3 Preparing a Medical Record
  116. Outcome
  117. Equipment/Supplies:
  118. Affix the name label.
  119. Insert the chart dividers into the metal fasteners.
  120. Place the patient registration form in front of the medical record.
  121. Medical Record Supplies
  122. File Folders
  123. Folder Labels
  124. Chart Dividers
  125. Taking a Health History
  126. Components of the Health History
  127. Identification Data
  128. Chart Divider Subject Titles and Documents Typically Filed Under Each Title
  129. History and Physical
  130. Progress Notes
  131. Laboratory/X-ray
  132. Hospital
  133. Correspondence
  134. Insurance
  135. Miscellaneous
  136. Memories of Practicum
  137. What Would You Do? What Would You Not Do?
  138. Case Study 3
  139. Chief Complaint
  140. Recording Chief Complaints
  141. Correct Examples
  142. Incorrect Examples
  143. Present Illness
  144. Past History
  145. Figure 1-22 Health history form.
  146. Family History
  147. Social History
  148. Review of Systems
  149. Charting in the Medical Record
  150. PPR Charting Guidelines
  151. Common Symptoms
  152. Charting Progress Notes
  153. Charting Patient Symptoms
  154. Other Activities That Need to Be Charted
  155. Procedures
  156. Procedure.
  157. Figure 1-23 Proper method for correcting an error in a patient’s medical record.
  158. Abbreviations and Symbols Commonly Used in the Medical Office*
  159. Administration of Medication
  160. Administration of medication.
  161. Specimen Collection
  162. Specimen collection.
  163. Diagnostic Procedures and Laboratory Tests
  164. Diagnostic/laboratory tests.
  165. Results of Laboratory Tests
  166. Laboratory test results.
  167. Patient Instructions
  168. Figure 1-24 Instruction sheet for patients.
  169. Patient instructions.
  170. Telephone call and missed appointment.
  171. Procedure 1-4 Obtaining and Recording Patient Symptoms
  172. Outcome
  173. Equipment/Supplies:
  174. What Questions:
  175. Where Question:
  176. When Questions:
  177. Medical Practice and the Law
  178. What Would You Do? What Would You Not Do? Responses
  179. Case Study 1
  180. What Did Dawn Do?
  181. What Did Dawn Not Do?
  182. Case Study 2
  183. What Did Dawn Do?
  184. What Did Dawn Not Do?
  185. Case Study 3
  186. What Did Dawn Do?
  187. What Did Dawn Not Do?
  188.  Certification Review
  189.  Terminology Review
  190.  On The Web
  191. Chapter 2 Medical Asepsis and the OSHA Standard
  192. Key Terms
  193. Introduction to Medical Asepsis and the OSHA Standard
  194. Microorganisms and Medical Asepsis
  195. Growth Requirements for Microorganisms
  196. Infection Process Cycle
  197. Protective Mechanisms of the Body
  198. Medical Asepsis in the Medical Office
  199. Hand Hygiene
  200. Figure 2-1 The infection process cycle.
  201. Box 2-1 CDC Guidelines for Hand Hygiene in Health Care Settings
  202. Resident and Transient Flora
  203. Handwashing
  204. Putting It All Into Practice
  205. Figure 2-2 A, Antimicrobial soap. B, Alcohol-based hand rubs.
  206. Antiseptic Handwashing
  207. Alcohol-Based Hand Rubs
  208. Infection Control
  209. Gloves
  210. Types of Gloves
  211. Glove Guidelines
  212.  Procedure 2-1  Handwashing
  213. Outcome
  214. Equipment/Supplies:
  215. Turn on the faucets using a paper towel.
  216. Apply soap to the hands.
  217. Wash the palms and the backs of the hands.
  218. Interlace the fingers and thumbs, and use friction.
  219. Rinse well, holding the hands lower than the elbows.
  220. Wash wrists and forearms using friction.
  221. Dry the hands gently and thoroughly.
  222.  Procedure 2-2  Applying an Alcohol-Based Hand Rub
  223. Outcome
  224. Equipment/Supplies:
  225. Apply lotion equal to the size of a dime.
  226. Apply foam equal to the size of a walnut.
  227. Rub the hands together until they are dry.
  228.  Procedure 2-3  Application and Removal of Clean Disposable Gloves
  229. Outcome
  230. Equipment/Supplies:
  231. Applying Clean Disposable Gloves
  232. Apply the gloves.
  233. Removing Clean Disposable Gloves
  234. Grasp the glove 1 to 2 inches from the top of the glove.
  235. Scrunch the glove into a ball.
  236. Place the index and middle fingers inside the glove.
  237. Discard both gloves in an appropriate container.
  238. Highlight on Latex Glove Allergy
  239. Latex Gloves
  240. Cause of Latex Glove Allergy
  241. Latex Glove Sensitivity Reactions
  242. Treatment
  243. NIOSH Recommendations
  244. Latex glove allergy.
  245. OSHA Bloodborne Pathogens Standard
  246. Purpose of the Standard
  247. Needlestick Safety and Prevention Act
  248. What Would You Do? What Would You Not Do?
  249. Case Study 1
  250. OSHA Terminology
  251. Components of the OSHA Standard
  252. Exposure Control Plan
  253. Figure 2-3 Example of an exposure control plan.
  254. Labeling Requirements
  255. Figure 2-4 A, Biohazard warning label. B, Biohazard bag used to hold and transport blood or other potentially infectious materials.
  256. Communicating Hazards to Employees
  257. Record Keeping
  258. Control Measures
  259. Engineering Controls
  260. OSHA Postexposure Evaluation and Follow-up Procedures
  261. Figure 2-5 A-B, Safety-engineered syringes. C, Safety-engineered phlebotomy device.
  262. Safer Medical Devices
  263. Work Practice Controls
  264. Personal Protective Equipment
  265. Personal Protective Equipment Guidelines
  266. 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.
  267. Figure 2-7 Examples of eye-protection devices. Left, Face shield; center, goggles; right, glasses with solid side shields.
  268. Housekeeping
  269. Figure 2-8 Clean and decontaminate work surfaces with an appropriate disinfectant after completing procedures involving blood and other potentially infectious materials.
  270. Figure 2-9 Use mechanical means to pick up broken contaminated glass.
  271. Figure 2-10 Biohazard sharps container.
  272. What Would You Do? What Would You Not Do?
  273. Case Study 2
  274. Highlight on OSHA Bloodborne Pathogens Standard
  275. General Information
  276. Control Measures
  277. Needlestick Injuries
  278. Figure 2-11 Hepatitis B declination form. This form must be signed by an employee with occupational exposure who declines hepatitis B vaccination.
  279. Hepatitis B Vaccination
  280. Universal Precautions
  281. Regulated Medical Waste
  282. Handling Regulated Medical Waste
  283. Highlight on Hepatitis B Vaccine
  284. Box 2-2 Guidelines for Discarding Medical Waste in the Medical Office
  285. Disposal of Regulated Medical Waste
  286. Figure 2-12 Jennifer places a biohazard bag inside a cardboard box in preparation for pickup by the medical waste service.
  287. What Would You Do? What Would You Not Do?
  288. Case Study 3
  289. Bloodborne Diseases
  290. Hepatitis B
  291. Postexposure Prophylaxis
  292. Figure 2-13 Hepatitis B vaccine.
  293. Acute Viral Hepatitis B
  294. Chronic Viral Hepatitis B
  295. Memories of Practicum
  296. Hepatitis C
  297. Other Forms of Viral Hepatitis
  298. Acquired Immune Deficiency Syndrome
  299. Stages of AIDS
  300. Stage 1: Acute HIV Infection
  301. Stage 2: Asymptomatic Period
  302. Highlight on Viral Hepatitis
  303. Hepatitis B
  304. Hepatitis C
  305. Stage 3: Symptomatic Period
  306. Table 2-1 Forms of Viral Hepatitis
  307. Stage 4: AIDS
  308. Highlight on AIDS
  309. Prevalence
  310. Transmission
  311. HIV Testing
  312. CDC Definition of AIDS
  313. Treatment
  314. Box 2-3 AIDS-Defining Conditions
  315. Kaposi sarcoma.
  316. Candida.
  317. Transmission of AIDS
  318. Patient Teaching: Acquired Immune Deficiency Syndrome
  319. Teach Patients the Ways in Which HIV is Transmitted
  320. Teach Patients How to Prevent HIV Infection
  321. Teach Patients to Recognize the Symptoms of HIV Infection
  322. Medical Practice and the Law
  323. Ethics and Law
  324. What Would You Do? What Would You Not Do?: Responses
  325. Case Study 1
  326. What Did Jennifer Do?
  327. What Did Jennifer Not Do?
  328. Case Study 2
  329. What Did Jennifer Do?
  330. What Did Jennifer Not Do?
  331. Case Study 3
  332. What Did Jennifer Do?
  333. What Did Jennifer Not Do?
  334.  Certification Review
  335.  Terminology Review
  336.  On The Web
  337. Chapter 3 Sterilization and Disinfection
  338. Key Terms
  339. Introduction to Sterilization and Disinfection
  340. Definitions of Terms
  341. Hazard Communication Standard
  342. Hazard Communication Program
  343. Inventory of Hazardous Chemicals
  344. Labeling of Hazardous Chemicals
  345. Figure 3-1 A, Hazardous chemical container label. B, The label must indicate the possible hazards of the chemical.
  346. Container Label Requirements
  347. Material Safety Data Sheets
  348. What Would You Do? What Would You Not Do?
  349. Case Study 1
  350. Material Safety Data Sheet Requirements
  351. Figure 3-2 Material safety data sheet (MSDS).
  352. Employee Information and Training
  353. Putting It All Into Practice
  354. Sanitization
  355. Sanitizing Instruments
  356. Figure 3-3 Ultrasonic cleaner.
  357. Cleaning Instruments
  358. Manual Method
  359. Ultrasound Method
  360. Guidelines for Sanitizing Instruments
  361. Figure 3-4 Commercially available surgical instrument cleaners. Left, Instrument cleaner; center, stain remover; right, spray lubricant.
  362.  Procedure 3-1  Sanitization of Instruments
  363. Outcome
  364. Equipment/Supplies:
  365. Rinse instruments under warm water to remove organic matter.
  366. Manual Method for Cleaning Instruments
  367. Clean the surface of the instrument with a stiff nylon brush.
  368. Clean grooves, crevices, or serrations with a wire brush.
  369. Ultrasound Method for Cleaning Instruments
  370. Completely submerge instruments in the cleaning solution.
  371. Place the lid on the ultrasonic cleaner.
  372. Rinse thoroughly with warm water.
  373. Dry the instrument with a paper towel.
  374. Check the instrument for defects and proper working order.
  375. Scissors should cut through gauze without catching.
  376. Lubricate hinged instruments.
  377. Disinfection
  378. Levels of Disinfection
  379. High-Level Disinfection
  380. Intermediate-Level Disinfection
  381. Low-Level Disinfection
  382. Types of Disinfectants
  383. Glutaraldehyde
  384. Alcohol
  385. Table 3-1 Disinfectants Used in the Medical Office
  386. Figure 3-5 Kara wears utility gloves and safety goggles to protect herself from the irritating effects of glutaraldehyde.
  387. Chlorine and Chlorine Compounds
  388. Phenolics
  389. Quaternary Ammonium Compounds
  390. What Would You Do? What Would You Not Do?
  391. Case Study 2
  392. Guidelines for Disinfection
  393. Sanitize Articles Before Disinfecting Them
  394. Observe Safety Precautions
  395. Properly Prepare and Use the Disinfectant
  396. Properly Store the Disinfectant
  397. Memories of Practicum
  398. Procedure 3-2  Chemical Disinfection of Articles
  399. Outcome
  400. Equipment/Supplies:
  401. Review the MSDS.
  402. Completely immerse the articles in the disinfectant.
  403. Cover the disinfectant container.
  404. Rinse articles thoroughly to remove the disinfectant.
  405. Sterilization
  406. Sterilization Methods
  407. Autoclave
  408. Items Sterilized in the Autoclave
  409. Monitoring Program
  410. Sterilization Indicators
  411. Chemical Indicators
  412. Figure 3-6 Example of an autoclave log.
  413. What Would You Do? What Would You Not Do?
  414. Case Study 3
  415. Biologic Indicators
  416. Figure 3-7 Example of a printout of an autoclave cycle.
  417. 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.
  418. 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.
  419. 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).
  420. Wrapping Articles
  421. Sterilization Paper
  422. Figure 3-11 Sterilization paper wraps. Sterilization paper consists of square sheets of paper that are available in different sizes.
  423. Sterilization Pouches
  424. Muslin
  425. Figure 3-12 Sterilization pouches. Sterilization pouches consist of a combination of paper and plastic and are available in different sizes.
  426.  Procedure 3-3  Wrapping Instruments Using Paper or Muslin
  427. Outcome
  428. Equipment/Supplies:
  429. Turn the wrap in a diagonal position.
  430. Place a sterilization indicator in the center of the pack next to the instrument.
  431. Fold the wrapping material up from the bottom, and double-back a small corner.
  432. Fold over the other edge of the wrapping material, and double-back the corner.
  433. Fold the pack up from the bottom.
  434. Label and date the pack. Include your initials.
  435.  Procedure 3-4  Wrapping Instruments Using a Pouch
  436. Outcome
  437. Equipment/Supplies:
  438. Label and date the pack. Include your initials.
  439. Insert the instrument into the pouch.
  440. Peel off the paper strip.
  441. Press firmly to seal the pack.
  442. Operating the Autoclave
  443. Guidelines for Autoclave Operation
  444. Location of the Autoclave
  445. Figure 3-13 The autoclave cycle for manual and automatic operation.
  446. Filling the Water Reservoir
  447. Loading the Autoclave
  448. 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.
  449. Figure 3-15 Jars and glassware should be placed on their sides in the autoclave with their lids removed.
  450. Table 3-2 Minimum Sterilizing Times
  451. Timing the Load
  452. Drying the Load
  453. Handling and Storing Packs
  454. Maintaining the Autoclave
  455. Daily Maintenance
  456. Weekly Maintenance
  457. Monthly Maintenance
  458. Other Sterilization Methods
  459. Dry Heat Oven
  460. Ethylene Oxide Gas Sterilization
  461. Cold Sterilization
  462. Radiation
  463.  Procedure 3-5  Sterilizing Articles in the Autoclave
  464. Outcome
  465. Equipment/Supplies:
  466. If needed, add distilled water to the autoclave.
  467. Manually Operated Autoclave
  468. Properly load the autoclave.
  469. Set the timing control.
  470. Crack the door to dry the load.
  471. Automatically Operated Autoclave
  472. Automatic autoclave buttons and indicators.
  473. Remove the load with heat-resistant gloves.
  474. Check the sterilization indicator on the outside of the pack.
  475. Clean the rubber gasket with a damp cloth.
  476. Medical Practice and the Law
  477. What Would You Do? What Would You Not Do?: Responses
  478. Case Study 1
  479. What Did Kara Do?
  480. What Did Kara Not Do?
  481. Case Study 2
  482. What Did Kara Do?
  483. What Did Kara Not Do?
  484. Case Study 3
  485. What Did Kara Do?
  486. What Did Kara Not Do?
  487.  Certification Review
  488.  Terminology Review
  489.  On the Web
  490. Chapter 4 Vital Signs
  491. Key Terms
  492. Introduction to Vital Signs
  493. Temperature
  494. Regulation of Body Temperature
  495. Heat Production
  496. Figure 4-1 Body temperature represents a balance between the heat produced in the body and the heat lost from the body.
  497. Heat Loss
  498. Body Temperature Range
  499. Alterations in Body Temperature
  500. Variations in Body Temperature
  501. 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.
  502. Table 4-1 Equivalent Fahrenheit and Celsius Temperatures
  503. Figure 4-3 Terms that describe alterations in body temperature (adult oral temperature).
  504. Fever
  505. Table 4-2 Variations in Body Temperature by Age
  506. Stages of a Fever
  507. Assessment of Body Temperature
  508. Assessment Sites
  509. Table 4-3 Fever Patterns
  510. Oral Temperature
  511. Putting It All Into Practice
  512. Highlight on Fever
  513. Axillary Temperature
  514. Rectal Temperature
  515. Aural Temperature
  516. Forehead Temperature
  517. Types of Thermometers
  518. Electronic Thermometer
  519. Figure 4-4 Electronic thermometer.
  520. Tympanic Membrane Thermometer
  521. Temporal Artery Thermometer
  522. Figure 4-5 The tympanic membrane thermometer functions by detecting thermal energy that is naturally radiated from the tympanic membrane.
  523. Figure 4-6 Tympanic membrane thermometer.
  524. Figure 4-7 Temporal artery thermometer.
  525. Earlobe Temperature Measurement
  526. Care and Maintenance
  527. Guidelines for Using a Tympanic Membrane Thermometer
  528. Box 4-1 Temporal Artery Thermometer Guidelines
  529. Chemical Thermometers
  530. Disposable Chemical Single-Use Thermometers
  531. 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.
  532. Temperature-Sensitive Strips
  533. 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.
  534.  Procedure 4-1  Measuring Oral Body Temperature—Electronic Thermometer
  535. Outcome
  536. Equipment/Supplies:
  537. Attach the oral probe to the thermometer.
  538. Slide the probe into a probe cover.
  539. Insert the probe under the patient’s tongue.
  540. The patient’s temperature appears as a digital display on the screen.
  541. Discard the probe cover by pressing the ejection button.
  542.  Procedure 4-2  Measuring Axillary Body Temperature—Electronic Thermometer
  543. Outcome
  544. Equipment/Supplies:
  545. Place the probe in the center of the patient’s axilla.
  546. Return the thermometer to its base.
  547.  Procedure 4-3  Measuring Rectal Body Temperature—Electronic Thermometer
  548. Outcome
  549. Equipment/Supplies:
  550. Apply a lubricant to the tip of the probe cover.
  551. Gently insert the probe inch into the rectum.
  552.  Procedure 4-4  Measuring Aural Body Temperature—Tympanic Membrane Thermometer
  553. Outcome
  554. Equipment/Supplies:
  555. Place a cover on the probe.
  556. When the thermometer is ready, it displays the word READY.
  557. Straighten the canal of adults and children older than 3 years by pulling the ear auricle upward and backward.
  558. Straighten the canal of children younger than 3 years by pulling the ear auricle downward and backward.
  559. Read the temperature on the digital display.
  560. Dispose of the probe cover.
  561.  Procedure 4-5  Measuring Temporal Artery Body Temperature
  562. Outcome
  563. Equipment/Supplies:
  564. Place a disposable probe cover on the thermometer.
  565. Position the probe on the center of the patient’s forehead.
  566. Slowly slide the probe straight across the patient’s forehead.
  567. Place the probe behind the ear lobe.
  568. Read the temperature.
  569. Wipe the probe with an antiseptic wipe.
  570. Pulse
  571. Mechanism of the Pulse
  572. Factors Affecting Pulse Rate
  573. Table 4-4 Pulse Rates of Various Age Groups
  574. What Would You Do? What Would You Not Do?
  575. Case Study 1
  576. Pulse Sites
  577. Radial
  578. Memories of Practicum
  579. Figure 4-10 Pulse sites.
  580. Apical
  581. Brachial
  582. Ulnar
  583. Temporal
  584. 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.
  585. Carotid
  586. Femoral
  587. Popliteal
  588. Posterior Tibial
  589. Dorsalis Pedis
  590. Assessment of Pulse
  591. Pulse Rate
  592. Pulse Rhythm and Volume
  593. Patient Teaching: Aerobic Exercise
  594. What Is Aerobic Exercise?
  595. What Are the Benefits of an Aerobic Exercise Program?
  596. What Is Target Heart Rate?
  597. How Do I Determine My Target Heart Rate?
  598. How Often Should Aerobic Exercise Be Performed?
  599. Respiration
  600. Mechanism of Respiration
  601. Control of Respiration
  602. Figure 4-12 Inhalation and exhalation.
  603. What Would You Do? What Would You Not Do?
  604. Case Study 2
  605. Assessment of Respiration
  606. Respiratory Rate
  607. Figure 4-13 Exchange of oxygen and carbon dioxide between the alveoli of the lungs and the blood.
  608. Table 4-5 Respiratory Rates of Various Age Groups
  609. Rhythm and Depth of Respiration
  610. Color of the Patient
  611. Respiratory Abnormalities
  612. Patient Teaching: Chronic Obstructive Pulmonary Disease
  613. What Is COPD?
  614. How Many People Have COPD?
  615. What Causes COPD?
  616. What Types of Tests Might the Physician Order?
  617. What Treatment Might the Physician Prescribe?
  618. Table 4-6 Abnormal Breath Sounds
  619. Breath Sounds
  620. Pulse Oximetry
  621. Assessment of Oxygen Saturation
  622. Mechanism of Action
  623. Figure 4-14 Pulse oximeter.
  624. 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.
  625. Interpretation of Results
  626. Purpose of Pulse Oximetry
  627. Figure 4-16 Pulse oximeter monitor: controls, indicators, and displays.
  628. Components of the Pulse Oximeter
  629. Monitor
  630. Probe
  631. Figure 4-17 Disposable (top) and reusable (bottom) probes for the pulse oximeter.
  632. Figure 4-18 Applying a probe to the tip of a finger.
  633. Factors Affecting Pulse Oximetry
  634. Pulse Oximeter Care and Maintenance
  635.  Procedure 4-6  Measuring Pulse and Respiration
  636. Outcome
  637. Equipment/Supplies:
  638. Place the three middle fingers over the radial pulse site.
  639. Count the pulse for 30 seconds.
  640. Count the number of respirations for 30 seconds.
  641.  Procedure 4-7  Measuring Apical Pulse
  642. Outcome
  643. Equipment/Supplies:
  644. Insert the earpieces into your ears with the earpieces directed slightly forward.
  645. Count the number of beats for 30 seconds, and multiply by 2.
  646.  Procedure 4-8  Performing Pulse Oximetry
  647. Outcome
  648. Equipment/Supplies:
  649. Disinfect the probe with an antiseptic wipe.
  650. Connect the cable to the monitor by plugging it into the port on the monitor.
  651. Position the probe securely on the fingertip.
  652. Allow several seconds for the pulse oximeter to detect the pulse.
  653. Read the oxygen saturation value and pulse rate.
  654. Blood Pressure
  655. Mechanism of Blood Pressure
  656. Interpretation of Blood Pressure
  657. Table 4-7 Classification of Blood Pressure for Adults Age 18 and Older
  658. Pulse Pressure
  659. Factors Affecting Blood Pressure
  660. Table 4-8 Average Optimal Blood Pressure for Age
  661. Assessment of Blood Pressure: Manual Method
  662. Stethoscope
  663. What Would You Do? What Would You Not Do?
  664. Case Study 3
  665. Stethoscope Chest Piece
  666. Manual Sphygmomanometers
  667. Aneroid Sphygmomanometer
  668. Patient Teaching: Hypertension
  669. What Is High Blood Pressure?
  670. What Are the Symptoms of High Blood Pressure?
  671. What Causes High Blood Pressure?
  672. Uncontrollable Risk Factors
  673. Controllable Risk Factors
  674. What Can Happen if High Blood Pressure Is Not Treated?
  675. Can High Blood Pressure Be Cured?
  676. How Long Will I Undergo Treatment?
  677. Figure 4-19 A, The parts of a stethoscope. B, Types of chest pieces.
  678. Figure 4-20 The parts of an aneroid sphygmomanometer.
  679. Figure 4-21 The scale of the gauge of an aneroid sphygmomanometer.
  680. Mercury Sphygmomanometer
  681. Cuff Sizes
  682. Figure 4-22 A, Wall-mounted aneroid sphygmomanometer. B, Mobile floor-stand aneroid sphygmomanometer.
  683. Figure 4-23 The parts of a mercury sphygmomanometer.
  684. Table 4-9 Types of Blood Pressure Cuffs
  685. Figure 4-24 Blood pressure cuffs: child, adult, and thigh.
  686. Highlight on Stethoscopes
  687. 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.
  688. Korotkoff Sounds
  689. 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.
  690. Prevention of Errors in Blood Pressure Measurement
  691. Table 4-10 Korotkoff Sounds
  692. Assessment of Blood Pressure: Automatic Method
  693. Advantages
  694. 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).
  695. Disadvantages
  696.  Procedure 4-9  Measuring Blood Pressure
  697. Outcome
  698. Equipment/Supplies:
  699. Rotate the chest piece to the diaphragm position.
  700. The inner bladder should encircle at least 80% of the patient’s arm.
  701. Center the inner bladder over the brachial pulse site.
  702. Locate the brachial pulse again before placing the diaphragm over the site.
  703. Pump air into the cuff as rapidly as possible.
  704. Release the pressure at a moderately steady rate.
  705. Procedure 4-10  Determining Systolic Pressure by Palpation
  706. Outcome
  707. Equipment/Supplies:
  708. Release the valve while palpating the radial artery.
  709. Medical Practice and the Law
  710. What Would You Do? What Would You Not Do?: Responses
  711. Case Study 1
  712. What Did Sergio Do?
  713. What Did Sergio Not Do?
  714. Case Study 2
  715. What Did Sergio Do?
  716. What Did Sergio Not Do?
  717. Case Study 3
  718. What Did Sergio Do?
  719. What Did Sergio Not Do?
  720.  Certification Review
  721. Temperature
  722. Pulse
  723. Respiration
  724. Pulse Oximetry
  725. Blood Pressure
  726.  Terminology Review
  727.  On the Web
  728. Chapter 5 The Physical Examination
  729. Key Terms
  730. Introduction to the Physical Examination
  731. Definitions of Terms
  732. Preparation of the Examining Room
  733. Highlight on Health Screening
  734. Table 5-1 Equipment and Supplies for the Physical Examination
  735. Preparation of the Patient
  736. Figure 5-1 Common instruments and supplies used during the physical examination.
  737. Measuring Weight and Height
  738. Table 5-2 Interpretation of Body Mass Index
  739. Highlight on Patient Teaching
  740. What Would You Do? What Would You Not Do?
  741. Case Study 1
  742. Putting It All Into Practice
  743. 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.
  744. What Would You Do? What Would You Not Do?
  745. Case Study 2
  746. Highlight on Cultural Diversity
  747. Guidelines for Achieving Cultural Competence
  748. Patient Teaching: Health Promotion and Disease Prevention
  749. Guidelines for Measuring Weight and Height
  750. Weight
  751. 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.
  752. Weight Conversion
  753. Height Conversion
  754. Height
  755. Figure 5-4 Calibration markings for measuring height on an upright balance scale.
  756. 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.
  757. Highlight on Body Mass Index
  758. Body Mass Index
  759. Determining BMI
  760. Adult Obesity
  761.  Procedure 5-1  Measuring Weight and Height
  762. Outcome
  763. Equipment/Supplies:
  764. Weight
  765. Ensure that the upper and lower weights are on zero.
  766. Correct the balance by adjusting the screw on the balance knob.
  767. Slide the upper weight by tapping it gently.
  768. Height
  769. Slide the bar upward until it is well above the patient’s height.
  770. Lower the bar until it rests on top of the patient’s head.
  771. Read the measurement to the nearest quarter-inch marking.
  772. Body Mechanics
  773. Principles
  774. Figure 5-6 Vertebral column.
  775. Application of Body Mechanics
  776. Standing
  777. Sitting
  778. Figure 5-7 Proper standing position.
  779. Figure 5-8 Proper sitting position.
  780. Lifting
  781. 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.
  782. Positioning and Draping
  783.  Procedure 5-2  Sitting Position
  784. Outcome
  785. Equipment/Supplies:
  786. Sitting position.
  787. Place the drape over the patient’s thighs and legs.
  788.  Procedure 5-3  Supine Position
  789. Outcome
  790. Equipment/Supplies:
  791. Pull out the table extension while supporting the patient’s legs.
  792. Position the patient on the back with the legs together.
  793. Place a drape lengthwise over the patient.
  794.  Procedure 5-4  Prone Position
  795. Outcome
  796. Equipment/Supplies:
  797. Position the patient’s legs together with the head turned to one side.
  798. Place a drape lengthwise over the patient.
  799.  Procedure 5-5  Dorsal Recumbent Position
  800. Outcome
  801. Equipment/Supplies:
  802. Ask the patient to bend the knees and place each foot at the edge of the examining table.
  803. Place a drape diagonally over the patient.
  804.  Procedure 5-6  Lithotomy Position
  805. Outcome
  806. Equipment/Supplies:
  807. Ask the patient to slide the buttocks to the edge of the table and to rotate the thighs outward.
  808. Position the drape diagonally.
  809.  Procedure 5-7  Sims Position
  810. Outcome
  811. Equipment/Supplies:
  812. The right leg is flexed sharply, and the left leg is flexed slightly.
  813. Adjust the drape as needed.
  814.  Procedure 5-8  Knee-Chest Position
  815. Outcome
  816. Equipment/Supplies:
  817. The buttocks are elevated, and the head is turned to one side.
  818. Position the drape diagonally.
  819.  Procedure 5-9  Fowler’s Position
  820. Outcome
  821. Equipment/Supplies:
  822. Ask the patient to lean back against the table head.
  823. Position the table at a 45-degree angle for the semi-Fowler’s position.
  824. Wheelchair Transfer
  825. Figure 5-10 Transfer belts. A, Transfer belt that is 48 inches in length. B, Transfer belt that is 60 inches in length.
  826.  Procedure 5-10  Wheelchair Transfer
  827. Outcome
  828. Equipment/Supplies:
  829. Transferring the Patient to the Examining Table
  830. Position the wheelchair at a 45-degree angle.
  831. Lock the brakes.
  832. Grasp the transfer belt on either side of the patient’s waist.
  833. Assist the patient to a standing position.
  834. Position the patient toward the table.
  835. Gradually lower the patient onto the table.
  836. Transferring the Patient to the Wheelchair
  837. Ask the patient to put his or her arms on your shoulders.
  838. Assist the patient to a standing position.
  839. Instruct the patient to step down from the footrest.
  840. Gradually lower the patient into the wheelchair.
  841. Assessment of the Patient
  842. Table 5-3 Physician Assessment During the Physical Examination
  843. Figure 5-11 A preprinted form for recording the results of the physical examination.
  844. Memories of Practicum
  845. Inspection
  846. Palpation
  847. Percussion
  848. Auscultation
  849. Figure 5-12 Palpation is examination of the body using the sense of touch.
  850. 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.
  851. What Would You Do? What Would You Not Do?
  852. Case Study 3
  853. Assisting the Physician
  854.  Procedure 5-11  Assisting With the Physical Examination
  855. Outcome
  856. Equipment/Supplies:
  857. Assemble the equipment.
  858. Greet and identify the patient by name and date of birth.
  859. Instruct and prepare the patient for the examination.
  860. Transfer the tongue depressor by holding it at the center.
  861. Unroll a fresh length of paper.
  862. Medical Practice and the Law
  863. What Would You Do? What Would You Not Do?: Responses
  864. Case Study 1
  865. What Did Hope Do?
  866. What Did Hope Not Do?
  867. Case Study 2
  868. What Did Hope Do?
  869. What Did Hope Not Do?
  870. Case Study 3
  871. What Did Hope Do?
  872. What Did Hope Not Do?
  873.  Certification Review
  874.  Terminology Review
  875.  On The Web
  876. Chapter 6 Eye and Ear Assessment and Procedures
  877. Key Terms
  878. Introduction to Eye and Ear Assessment
  879. The Eye
  880. Structure of the Eye
  881. Figure 6-1 The internal structure of the eye.
  882. Visual Acuity
  883. Figure 6-2 Diagram of normal refraction compared with myopia (nearsightedness) and hyperopia (farsightedness), which are errors of refraction that cause visual defects.
  884. Assessment of Distance Visual Acuity (DVA)
  885. Figure 6-3 Snellen eye chart consisting of letters in decreasing sizes; this chart is used to measure distance visual acuity.
  886. Conducting a Snellen Test
  887. 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.
  888. Assessing Distance Visual Acuity in Preschool Children
  889. Assessment of Near Visual Acuity (NVA)
  890. 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.
  891. Highlight on Eye Assessment
  892. Assessment of Color Vision
  893. What Would You Do? What Would You Not Do?
  894. Case Study 1
  895. Figure 6-6 Example of a near visual acuity card.
  896. 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.
  897. Ishihara Test
  898. Putting It All Into Practice
  899.  Procedure 6-1  Assessing Distance Visual Acuity—Snellen Chart
  900. Outcome
  901. Equipment/Supplies:
  902. Ask the patient to cover the right eye and to keep the left eye open.
  903. Ask the patient to identify one line at a time.
  904.  Procedure 6-2  Assessing Color Vision—Ishihara Test
  905. Outcome
  906. Equipment/Supplies:
  907. Hold the color plate 30 inches from the patient.
  908. Eye Irrigation
  909. Eye Instillation
  910. What Would You Do? What Would You Not Do?
  911. Case Study 2
  912. Patient Teaching: Conjunctivitis
  913. What Is Conjunctivitis?
  914. What Are the Symptoms of Conjunctivitis?
  915. Is Conjunctivitis Contagious?
  916. How Can We Avoid Spreading Conjunctivitis?
  917. Bacterial conjunctivitis.
  918.  Procedure 6-3  Performing an Eye Irrigation
  919. Outcome
  920. Equipment/Supplies:
  921. Cleanse the eyelids from inner to outer canthus.
  922. Separate the eyelids, and hold the tip of the syringe 1 inch above the eye.
  923.  Procedure 6-4   Performing an Eye Instillation
  924. Outcome
  925. Equipment/Supplies:
  926. Ask the patient to look up, and insert the medication.
  927. The Ear
  928. Structure of the Ear
  929. Assessment of Hearing Acuity
  930. Types of Hearing Loss
  931. Figure 6-8 Structure of the ear.
  932. What Would You Do? What Would You Not Do?
  933. Case Study 3
  934. Hearing Acuity Tests
  935. Gross Screening Test
  936. Tuning Fork Tests
  937. Audiometry
  938. Figure 6-9 Weber test.
  939. Figure 6-10 Rinne test.
  940. Tympanometry
  941. Memories from Externship
  942. Figure 6-11 A, Audiometer. B, The patient signals when he hears a sound.
  943. Figure 6-12 A, Tympanometer. B, The earpiece is placed snugly in the patient’s ear.
  944. Ear Irrigation
  945. Patient Teaching: Acute Otitis Media
  946. What Is a Middle Ear Infection?
  947. What Causes a Middle Ear Infection?
  948. What Are the Symptoms of a Middle Ear Infection?
  949. How Does the Physician Know Whether a Middle Ear Infection Is Present?
  950. Chronic otitis media.
  951. How Is the Infection Treated?
  952. Serous otitis media.
  953. Why Are Middle Ear Infections So Common in Children?
  954. Ear Instillation
  955. Highlight on Hearing Impairment
  956.  Procedure 6-5   Performing an Ear Irrigation
  957. Outcome
  958. Equipment/Supplies:
  959. Assemble the equipment.
  960. Inject the irrigating solution toward the roof of the ear canal.
  961.  Procedure 6-6   Performing an Ear Instillation
  962. Outcome
  963. Equipment/Supplies:
  964. Instill the medication along the side of the ear canal.
  965. Medical Practice and the Law
  966. Patient Rights
  967. What Would You Do? What Would You Not Do?: Responses
  968. Case Study 1
  969. What Did Cammie Do?
  970. What Did Cammie Not Do?
  971. Case Study 2
  972. What Did Cammie Do?
  973. What Did Cammie Not Do?
  974. Case Study 3
  975. What Did Cammie Do?
  976. What Did Cammie Not Do?
  977.  Certification Review
  978.  Terminology Review
  979.  On The Web
  980. Chapter 7 Physical Agents to Promote Tissue Healing
  981. Key Terms
  982. Introduction to Tissue Healing
  983. Local Application of Heat and Cold
  984. Putting it All into Practice
  985. Factors Affecting the Application of Heat and Cold
  986. Heat
  987. Local Effects of Heat
  988. Purpose of Applying Heat
  989. Types of Heat Applications
  990. Heating Pad
  991. Hot Soak
  992. Hot Compress
  993. Figure 7-1 Effects of the local application of heat and cold.
  994. Chemical Hot Pack
  995. What Would You Do? What Would You Not Do?
  996. Case Study 1
  997. Cold
  998. Local Effects of Cold
  999. Purpose of Applying Cold
  1000. Types of Cold Applications
  1001. Ice Bag
  1002. Cold Compress
  1003. Chemical Cold Pack
  1004.  Procedure 7-1  Applying a Heating Pad
  1005. Outcome
  1006. Equipment/Supplies:
  1007. Place the heating pad in a protective covering.
  1008.  Procedure 7-2  Applying a Hot Soak
  1009. Outcome
  1010. Equipment/Supplies:
  1011. Replace cooler solution with hot solution.
  1012.  Procedure 7-3  Applying a Hot Compress
  1013. Outcome
  1014. Equipment/Supplies:
  1015. Wring out the compress.
  1016. Apply the compress to the affected site.
  1017.  Procedure 7-4  Applying an Ice Bag
  1018. Outcome
  1019. Equipment/Supplies:
  1020. Expel air from the bag.
  1021.  Procedure 7-5  Applying a Cold Compress
  1022. Outcome
  1023. Equipment/Supplies:
  1024. Place large ice cubes in the basin.
  1025.  Procedure 7-6  Applying a Chemical Pack
  1026. Outcome
  1027. Chemical packs.
  1028. Patient Teaching: Low Back Pain
  1029. What Causes Low Back Pain?
  1030. How Might the Physician Treat Low Back Pain?
  1031. What Can Be Done to Prevent Low Back Pain?
  1032. Patient Teaching: Body Mechanics
  1033. Standing and Walking
  1034. Lifting
  1035. Sitting
  1036. Driving
  1037. Sleeping
  1038. Figure 7-2 A fracture of the tibia in the left lower leg.
  1039. Casts
  1040. Figure 7-3 Pressure ulcer.
  1041. Memories of Practicum
  1042. Synthetic Casts
  1043. Cast Application
  1044. Figure 7-4 A roll of synthetic tape comes packaged in an airtight pouch.
  1045. Figure 7-5 Types of casts.
  1046. Figure 7-6 Application of a stockinette.
  1047. Figure 7-7 Application of cast padding.
  1048. Figure 7-8 Wrapping the tape over the body part, using a spiral turn.
  1049. Precautions
  1050. Guidelines for Cast Care
  1051. Symptoms to Report
  1052. Cast Removal
  1053. 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.
  1054. What Would You Do? What Would You Not Do?
  1055. Case Study 2
  1056. Splints and Braces
  1057. Figure 7-10 Arm splint.
  1058. Figure 7-11 Short leg walker, which is an example of a leg brace.
  1059. Patient Teaching: Cast Care
  1060. Ambulatory Aids
  1061. Crutches
  1062. Highlight on Ambulatory Aids
  1063. Figure 7-12 Types of crutches.
  1064. Axillary Crutch Measurement
  1065. Patient Teaching: Crutches
  1066. Crutch Guidelines
  1067. Crutch Gaits
  1068. Canes
  1069. Figure 7-13 Examples of a quad cane (left) and a standard cane (right).
  1070. Walkers
  1071. Figure 7-14 Walkers.
  1072. What Would You Do? What Would You Not Do?
  1073. Case Study 3
  1074.  Procedure 7-7  Measuring for Axillary Crutches
  1075. Outcome
  1076. Determining Crutch Length
  1077. Position for measuring for crutches.
  1078. Handgrip Positioning
  1079. Insert two fingers between the top of the crutch and the axilla.
  1080.  Procedure 7-8  Instructing a Patient in Crutch Gaits
  1081. Outcome
  1082. Tripod Position
  1083. Tripod position.
  1084. Four-Point Gait
  1085. Two-Point Gait
  1086. Three-Point Gait
  1087. Swing Gaits
  1088.  Procedure 7-9  Instructing a Patient in Use of a Cane
  1089. Outcome
  1090.  Procedure 7-10  Instructing a Patient in Use of a Walker
  1091. Outcome
  1092. Medical Practice and the Law
  1093. What Would You Do? What Would You Not Do?: Responses
  1094. Case Study 1
  1095. What Did Marlyne Do?
  1096. What Did Marlyne Not Do?
  1097. Case Study 2
  1098. What Did Marlyne Do?
  1099. What Did Marlyne Not Do?
  1100. Case Study 3
  1101. What Did Marlyne Do?
  1102. What Did Marlyne Not Do?
  1103.  Certification Review
  1104.  Terminology Review
  1105.  On the Web
  1106. Chapter 8 The Gynecologic Examination and Prenatal Care
  1107. Key Terms
  1108. Introduction to the Gynecologic Examination and Prenatal Care
  1109. Gynecologic Examination
  1110. Gynecology
  1111. Figure 8-1 The female reproductive system.
  1112. Terms Related to Gynecology
  1113. Breast Examination
  1114. Putting It All into Practice
  1115. Patient Teaching: Breast Self-Examination
  1116. When Should I Examine My Breasts?
  1117. Why Is It Important to Examine My Breasts Every Month?
  1118. What Is Considered Normal?
  1119. What Should be Reported to the Physician?
  1120. What Would You Do? What Would You Not Do?
  1121. Case Study 1
  1122. Pelvic Examination
  1123. Inspection of External Genitalia, Vagina, and Cervix
  1124. Figure 8-2 Insertion of the vaginal speculum for visualization of the vagina and cervix.
  1125. Pap Test
  1126. Highlight on Breast Cancer
  1127. Survival Rate
  1128. Recommendations for Early Detection
  1129. Risk Factors
  1130. Warning Signs
  1131. Diagnosis
  1132. Patient Instructions
  1133. Specimen Collection
  1134. Vaginal Specimen
  1135. Figure 8-3 Obtaining the Pap specimen.
  1136. Cervical Specimen
  1137. Endocervical Specimen
  1138. Preparation Methods
  1139. Direct Smear
  1140. Liquid-Based Preparation
  1141. Figure 8-4 Collecting a Pap specimen using a broom.
  1142. Cytology Request
  1143. General Information
  1144. Date and Time of Collection
  1145. Collection Method
  1146. Source of the Specimen
  1147. Collection Technique
  1148. Patient History
  1149. Previous Treatment
  1150. Evaluation of the Pap Specimen
  1151. Maturation Index
  1152. Figure 8-5 Cytology request form.
  1153. Cytology Report
  1154. Figure 8-6 Cytology report form (The Bethesda System).
  1155. Table 8-1 Pap Test Results
  1156. Bimanual Pelvic Examination
  1157. Figure 8-7 The bimanual pelvic examination.
  1158. Rectal-Vaginal Examination
  1159.  Procedure 8-1  Breast Self-Examination Instructions
  1160. Outcome
  1161. Equipment/Supplies:
  1162. Before a Mirror
  1163. Raise your arms over your head.
  1164. Press down firmly to flex the chest muscles.
  1165. Lying Down
  1166. Use the pads of the middle three fingers.
  1167. Use one of three patterns to examine the breasts.
  1168. Circular
  1169. Vertical Strip
  1170. Wedge
  1171. Examine the right breast.
  1172. In the Shower
  1173. Examine the breasts in the shower.
  1174.  Procedure 8-2  Assisting With a Gynecologic Examination
  1175. Outcome
  1176. Equipment/Supplies:
  1177. Assemble equipment.
  1178. Instruct and prepare the patient for the examination.
  1179. Vigorously swirl the spatula in the preservative.
  1180. Rotate the brush in the preservative.
  1181. Push the broom vigorously into the bottom of the vial.
  1182. Hold the gauze with the lubricant for the physician.
  1183. Insert the laboratory request into the outside pocket.
  1184. Vaginal Infections
  1185. Trichomoniasis
  1186. Figure 8-8 Trichomonas vaginalis under a microscope.
  1187. Candidiasis
  1188. Figure 8-9 Preparing a wet preparation for the identification of Trichomonas vaginalis.
  1189. Figure 8-10 Candida albicans under a microscope.
  1190. Chlamydia
  1191. Gonorrhea
  1192. Highlight on Sexually Transmitted Diseases
  1193. Transmission
  1194. Symptoms
  1195. Treatment
  1196. Plan of Action
  1197. Prevention and Control
  1198. Chlamydia and Gonorrhea Specimen Collection
  1199. DNA-Based Detection Test
  1200. The physician inserts the swab into the tube and breaks off the shaft.
  1201. What Would You Do? What Would You Not Do?
  1202. Case Study 2
  1203. Memories of Practicum
  1204. Prenatal Care
  1205. Obstetrics
  1206. Obstetric Terminology
  1207. Prenatal Visits
  1208. First Prenatal Visit
  1209. Prenatal Record
  1210. Figure 8-11 Example of a prenatal record form.
  1211. Past Medical History
  1212. Menstrual History
  1213. Obstetric History
  1214. Present Pregnancy History
  1215. Interval Prenatal History
  1216. Initial Prenatal Examination
  1217. Purpose
  1218. Figure 8-12 Gestation calculator. The last menstrual period is July 20, and the expected date of delivery is April 25.
  1219. Preparation of the Patient
  1220. Patient Education
  1221. Warning Signs During Pregnancy
  1222. Signs of Infection
  1223. Signs of Spontaneous Abortion
  1224. Signs of Preeclampsia
  1225. Signs of Placental or Fetal Problems
  1226. Signs of Preterm Labor
  1227. Laboratory Tests
  1228. Table 8-2 Components of the Initial Prenatal Examination
  1229. Urine Tests
  1230. Urinalysis
  1231. Swab Tests
  1232. Pap Test
  1233. Chlamydia and Gonorrhea
  1234. Trichomoniasis and Candidiasis
  1235. Group B Streptococcus
  1236. What Would You Do? What Would You Not Do?
  1237. Case Study 3
  1238. Blood Tests
  1239. Complete Blood Count
  1240. Hemoglobin and Hematocrit
  1241. Rh Factor and ABO Blood Type
  1242. Glucose Challenge Test
  1243. Syphilis Test
  1244. Highlight on Gestational Diabetes Mellitus
  1245. Definition of Gestational Diabetes Mellitus
  1246. Cause of Gestational Diabetes Mellitus
  1247. Problems for the Child
  1248. Problems for the Mother
  1249. Risk Factors for Gestational Diabetes Mellitus
  1250. Treatment
  1251. Rubella Antibody Titer
  1252. Rh Antibody Titer (On Rh-Negative Blood Specimens)
  1253. Hepatitis B and Human Immunodeficiency Virus
  1254. Return Prenatal Visits
  1255. Fundal Height Measurement
  1256. 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.
  1257. Figure 8-14 Fundal height showing gestational age in weeks.
  1258. Fetal Heart Tones
  1259. 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.
  1260. Vaginal Examination
  1261. What Would You Do? What Would You Not Do?
  1262. Case Study 4
  1263. 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).
  1264. Special Tests and Procedures
  1265. Multiple Marker Test
  1266. Figure 8-17 Obstetric ultrasound scan.
  1267. Obstetric Ultrasound Scan
  1268. Transabdominal Ultrasound Scan
  1269. Box 8-1 Purpose of Obstetric Ultrasound Scanning
  1270. Between 7 and 12 Weeks
  1271. Embryo at approximately 9 weeks of gestation.
  1272. Between 18 and 20 Weeks
  1273. Erect fetal penis. 1, urethra; 2, corpus cavernosum; 3, shaft; 4, glans; 5, foreskin.
  1274. Twins.
  1275. External female genitalia. 1, major labium; 2, minor labium; 3, vaginal cleft; 4, thighs.
  1276. At 34 Weeks
  1277. Other Purposes
  1278. Amniocentesis being performed under ultrasound guidance.
  1279. Endovaginal Ultrasound Scan
  1280. Amniocentesis
  1281. Figure 8-18 Amniocentesis.
  1282. Fetal Heart Rate Monitoring
  1283. Medical Assisting Responsibilities
  1284. Patient Teaching: Obstetric Ultrasound Scan
  1285. What Is an Ultrasound Scan?
  1286. Why Is an Ultrasound Scan Performed?
  1287. What Preparation Is Needed?
  1288. Is an Ultrasound Scan Safe?
  1289. Can I Learn the Sex of My Baby Through an Ultrasound Scan?
  1290.  Procedure 8-3  Assisting with a Return Prenatal Examination
  1291. Outcome
  1292. Equipment/Supplies:
  1293. Set up the prenatal tray.
  1294. Measure the patient’s blood pressure.
  1295. Weigh the patient.
  1296. Apply a liberal amount of coupling gel.
  1297. Assist the patient off the examining table.
  1298. Six Weeks Postpartum Visit
  1299. Table 8-3 Six Weeks Postpartum Examination
  1300. Medical Practice and the Law
  1301. Mature Minor
  1302. What Would You Do? What Would You Not Do?: Responses
  1303. Case Study 1
  1304. What Did Yin-Ling Do?
  1305. What Did Yin-Ling Not Do?
  1306. Case Study 2
  1307. What Did Yin-Ling Do?
  1308. What Did Yin-Ling Not Do?
  1309. Case Study 3
  1310. What Did Yin-Ling Do?
  1311. What Did Yin-Ling Not Do?
  1312. Case Study 4
  1313. What Did Yin-Ling Do?
  1314. What Did Yin-Ling Not Do?
  1315.  Certification Review
  1316.  Terminology Review
  1317.  On The Web
  1318. Chapter 9 The Pediatric Examination
  1319. Key Terms
  1320. Introduction to the Pediatric Examination
  1321. Pediatric Office Visits
  1322. What Would You Do? What Would You Not Do?
  1323. Case Study 1
  1324. Table 9-1 Milestones of Gross and Fine Motor Development in Infancy
  1325. 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.
  1326. Developing a Rapport
  1327. Table 9-2 Techniques for Interaction With Children
  1328. Carrying the Infant
  1329. Cradle Position
  1330. Upright Position
  1331. Figure 9-2 Traci holds the infant in the cradle position.
  1332. Figure 9-3 Traci holds the infant in the upright position.
  1333. Growth Measurements
  1334. Figure 9-4 Measuring the height of a child.
  1335. Weight
  1336. Length and Height
  1337. Head and Chest Circumference
  1338. Putting it All into Practice
  1339. Highlight on Childhood Obesity
  1340. Statistics
  1341. Causes
  1342. Related Problems
  1343. Prevention
  1344. Treatment
  1345. Growth Charts
  1346.  Procedure 9-1  Measuring the Weight and Length of an Infant
  1347. Outcome
  1348. Equipment/Supplies:
  1349. Balance the scale.
  1350. Read the results in pounds and ounces.
  1351. Properly position the infant.
  1352. Read the length in inches.
  1353.  Procedure 9-2 Measuring Head and Chest Circumference of an Infant
  1354. Outcome
  1355. Equipment/Supplies:
  1356. Measurement of Head Circumference
  1357. Position the tape measure around the infant’s head.
  1358. Measurement of Chest Circumference
  1359. Encircle the tape around the infant’s chest.
  1360.  Procedure 9-3 Calculating Growth Percentiles
  1361. Outcome
  1362. Equipment/Supplies:
  1363. Pediatric Blood Pressure Measurement
  1364. Special Guidelines for Children
  1365. Correct Cuff Size
  1366. Cooperation of the Child
  1367. Table 9-3 Acceptable Bladder Dimensions for Arms of Different Sizes
  1368. Figure 9-5 Determination of proper blood pressure cuff size.
  1369. Figure 9-6 Traci measures the blood pressure of a pediatric patient.
  1370. What Would You Do?  What Would You Not Do?
  1371. Case Study 2
  1372. Blood Pressure Classifications
  1373. Memories of Practicum
  1374. Collection of a Urine Specimen
  1375.  Procedure 9-4  Applying a Pediatric Urine Collector
  1376. Outcome
  1377. Equipment/Supplies:
  1378. Remove paper backing from the urine collector bag.
  1379. Firmly press the adhesive surface to the skin surrounding the external genitalia.
  1380. 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.
  1381. Pediatric Injections
  1382. Types of Needles
  1383. Intramuscular Injection Sites
  1384. Figure 9-7 Dorsogluteal intramuscular injection site.
  1385. 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.
  1386. Figure 9-9 A, Compression of the vastus lateralis muscle. B, IM injection into the vastus lateralis injection site.
  1387. Immunizations
  1388. Figure 9-10 Deltoid intramuscular injection site.
  1389. Figure 9-11 Recommended immunization schedule for persons aged 0 through 18 years.
  1390. Table 9-4 Infant and Childhood Immunizations
  1391. Table 9-5 Infant and Childhood Combination Immunizations
  1392. National Childhood Vaccine Injury Act
  1393. Figure 9-12 Immunization record card.
  1394. What Would You Do?  What Would You Not Do?
  1395. Case Study 3
  1396. Newborn Screening Test
  1397. Figure 9-13 Vaccine information statement for diphtheria, tetanus, and pertussis (DTaP).
  1398. Figure 9-14 Immunization administration record included in a patient’s medical record.
  1399. Figure 9-15 Newborn screening test card.
  1400. Patient Teaching: Childhood Immunizations
  1401. What is immunity?
  1402. How do immunizations prevent disease?
  1403. What childhood diseases can be prevented through immunization?
  1404. Haven’t most of these diseases been eliminated in the United States?
  1405. Do immunizations have side effects?
  1406. Are immunizations required by law?
  1407. Procedure 9-5 Newborn Screening Test
  1408. Outcome
  1409. Equipment/Supplies:
  1410. Assemble the equipment.
  1411. Plantar surface of the heel.
  1412. Warm the puncture site.
  1413. Grasp the infant’s foot, and make the puncture.
  1414. Completely fill the circle with the blood specimen.
  1415. Medical Practice and the Law
  1416. What Would You Do? What Would You Not Do?: Responses
  1417. Case Study 1
  1418. What Did Traci Do?
  1419. What Did Traci Not Do?
  1420. Case Study 2
  1421. What Did Traci Do?
  1422. What Did Traci Not Do?
  1423. Case Study 3
  1424. What Did Traci Do?
  1425. What Did Traci Not Do?
  1426.  Certification Review
  1427.  Terminology Review
  1428.  On The Web
  1429. Chapter 10 Minor Office Surgery
  1430. Key Terms
  1431. Introduction to Minor Office Surgery
  1432. Figure 10-1 Consent to treatment form.
  1433. Guidelines for Surgical Asepsis
  1434. Surgical Asepsis
  1435. Instruments Used in Minor Office Surgery
  1436. Scalpels
  1437. Figure 10-2 Parts of an instrument.
  1438. Scissors
  1439. Forceps
  1440. Miscellaneous Instruments
  1441. Gynecologic Instruments
  1442. Figure 10-3 Instruments used in minor office surgery.
  1443. Putting It All into Practice
  1444. Care of Surgical Instruments
  1445. Commercially Prepared Sterile Packages
  1446. 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.
  1447.  Procedure 10-1  Applying and Removing Sterile Gloves
  1448. Outcome
  1449. Equipment/Supplies:
  1450. Applying Sterile Gloves
  1451. Pick up the first glove on the inside of the cuff.
  1452. Pick up the second glove.
  1453. Turn back the cuff.
  1454. Removing Sterile Gloves
  1455. Grasp the outside of the glove.
  1456. Scrunch the glove into a ball.
  1457. Place the fingers on the inside of the glove.
  1458. Pull the glove off the hand.
  1459.  Procedure 10-2  Opening a Sterile Package
  1460. Outcome
  1461. Equipment/Supplies:
  1462. Check the sterilization indicator.
  1463. Open the first flap away from the body.
  1464. Open the left and right flaps.
  1465. Open the flap closest to the body.
  1466.  Procedure 10-3  Pouring a Sterile Solution
  1467. Outcome
  1468. Equipment/Supplies:
  1469. Pour the proper amount of solution.
  1470. Wounds
  1471. Wound Healing
  1472. Figure 10-5 Types of wounds.
  1473. Patient Teaching: Wound Care
  1474. Figure 10-6 Phases of wound healing.
  1475. Phases of Wound Healing
  1476. Phase 1
  1477. Phase 2
  1478. Phase 3
  1479. Wound Drainage
  1480. Sterile Dressing Change
  1481.  Procedure 10-4  Changing a Sterile Dressing
  1482. Outcome
  1483. Equipment/Supplies:
  1484. Side Table
  1485. Sterile Field
  1486. Prepare the side table.
  1487. Remove the soiled dressing.
  1488. Apply an antiseptic to the wound.
  1489. Prepare the sterile field.
  1490. Instruct the patient in wound care.
  1491. Sutures
  1492. Types of Sutures
  1493. Memories of Practicum
  1494. Figure 10-7 Swaged suture packets. A, Absorbable sutures. B, Nonabsorbable sutures.
  1495. 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.
  1496. Suture Size and Packaging
  1497. Suture Needles
  1498. Figure 10-9 Common suture needles. A, Needles with a cutting point. B, Eyed needles and a swaged needle.
  1499. Insertion of Sutures
  1500. Suture Insertion Setup
  1501. Items Placed to the Side of the Sterile Field
  1502. Suture insertion side table.
  1503. Items Included on the Sterile Field
  1504. Suture insertion sterile field.
  1505. Figure 10-10 Adding sutures to a sterile field.
  1506. Procedure: Suture Insertion
  1507. Postoperative Instructions: Suture Insertion
  1508. Suture Removal
  1509. What Would You Do? What Would You Not Do?
  1510. Case Study 1
  1511. Surgical Skin Staples
  1512. Figure 10-11 Disposable skin stapler.
  1513.  Procedure 10-5  Removing Sutures and Staples
  1514. Outcome
  1515. Equipment/Supplies:
  1516. For Suture Removal
  1517. For Staple Removal
  1518. Suture removal setup.
  1519. Staple removal setup.
  1520. Open the suture removal kit.
  1521. Cut the suture below the knot on the side closest to the skin.
  1522. Gently pull the suture out.
  1523. A, Place the bottom jaws of the staple remover under the staple. B, Firmly squeeze the staple handles until they are fully closed.
  1524. Adhesive Skin Closures
  1525. Figure 10-12 Adhesive skin closures in different sizes.
  1526.  Procedure 10-6  Applying and Removing Adhesive Skin Closures
  1527. Outcome
  1528. Equipment/Supplies:
  1529. Application of Adhesive Skin Closures
  1530. Assemble the equipment.
  1531. Clean the wound.
  1532. Apply an antiseptic to the wound.
  1533. Apply tincture of benzoin.
  1534. Peel a strip of tape off the card.
  1535. Position the first strip over the center of the wound.
  1536. Apply the strips until the edges of the wound are approximated.
  1537. Apply a strip along each edge.
  1538. Ask the patient to sign the instruction sheet.
  1539. Removal of Adhesive Skin Closures
  1540. Assisting with Minor Office Surgery
  1541. Tray Setup
  1542. Methods Used to Set Up a Sterile Tray
  1543. Side Table
  1544. Skin Preparation
  1545. Shaving the Site
  1546. Cleansing the Site
  1547. Figure 10-13 Cleansing solutions.
  1548. Antiseptic Application
  1549. Local Anesthetic
  1550. Figure 10-14 Fenestrated drape.
  1551. Preparing the Anesthetic
  1552. Assisting the Physician
  1553. 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.
  1554. Figure 10-16 Trudy hands a hemostat to the physician in its functional position.
  1555. Figure 10-17 Biopsy requisition.
  1556. What Would You Do? What Would You Not Do?
  1557. Case Study 2
  1558. Highlight on the History of Surgery
  1559. Primitive Surgery
  1560. Early 1800s
  1561. Mid-1800s
  1562. Late 1800s and Early 1900s
  1563.  Procedure 10-7  Assisting with Minor Office Surgery
  1564. Outcome
  1565. Equipment/Supplies:
  1566. Preparing the Tray
  1567. Open the sterile pack using the inside of the wrapper as the sterile field.
  1568. Lay the sterile towel down gently and slowly.
  1569. Arrange the articles neatly on the sterile field.
  1570. Cover the tray setup with a sterile towel.
  1571. Preparing the Patient
  1572. Cleanse the patient’s skin with an antiseptic solution.
  1573. Assisting the Physician
  1574. Hold a basin for the physician to deposit soiled instruments.
  1575. Hold the container to accept a tissue specimen.
  1576. Medical Office Surgical Procedures
  1577. Sebaceous Cyst Removal
  1578. Figure 10-18 Sebaceous cyst.
  1579. Sebaceous Cyst Setup
  1580. Items Placed to the Side of the Sterile Field
  1581. Figure 10-19 Sebaceous cyst removal. The physician makes an incision, removes the cyst, and sutures the surgical incision.
  1582. Sebaceous cyst removal side table.
  1583. Items Included on the Sterile Field
  1584. Procedure: Sebaceous Cyst Removal
  1585. Sebaceous cyst removal sterile field.
  1586. Postoperative Instructions: Sebaceous Cyst Removal
  1587. Surgical Incision and Drainage of Localized Infections
  1588. Incision and Drainage Setup
  1589. Items Placed to the Side of the Sterile Field
  1590. Figure 10-20 A, Staphylococcus skin abscess. B, An abscess is a collection of pus in a cavity surrounded by inflamed tissue.
  1591. Figure 10-21 Furuncle (boil) resulting from a Staphylococcus aureus infection.
  1592. Incision and drainage side table.
  1593. Items Included on the Sterile Field
  1594. Incision and drainage sterile field.
  1595. Procedure: Incision and Drainage
  1596. Postoperative Instructions: Incision and Drainage
  1597. Mole Removal
  1598. Figure 10-22 Skin tags.
  1599. Figure 10-23 Raised moles.
  1600. Figure 10-24 Dysplastic nevi.
  1601. 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).
  1602. Mole Shave Excision Setup
  1603. Items Placed to Side of the Sterile Field
  1604. Items Placed on the Sterile Field
  1605. Procedure: Mole Shave Excision
  1606. Surgical Mole Excision Setup
  1607. Items Placed to Side of the Sterile Field
  1608. Items Placed on the Sterile Field
  1609. Procedure: Surgical Mole Excision
  1610. Postoperative Instructions: Shave Excision and Surgical Excision
  1611. Laser Mole Surgery
  1612. Needle Biopsy
  1613. Needle Biopsy Setup
  1614. Items Placed to the Side of the Sterile Field
  1615. 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.
  1616. Items Included on the Sterile Field
  1617. Procedure: Needle Biopsy
  1618. Postoperative Instructions: Needle Biopsy
  1619. Ingrown Toenail Removal
  1620. Ingrown Toenail Removal Setup
  1621. 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.
  1622. Figure 10-28 Ingrown toenail.
  1623. Items Placed to the Side of the Sterile Field
  1624. Items Included on the Sterile Field
  1625. Procedure: Ingrown Toenail
  1626. Postoperative Instructions: Ingrown Toenail
  1627. Colposcopy
  1628. Figure 10-29 A colposcope.
  1629. Colposcopy Setup
  1630. Items Placed to the Side of the Sterile Field
  1631. Items Included on the Sterile Field
  1632. Procedure: Colposcopy
  1633. Figure 10-30 A, Normal cervix. B, Abnormal cervix.
  1634. Cervical Punch Biopsy
  1635. Cervical Punch Biopsy Setup
  1636. Items Placed to the Side of the Sterile Field
  1637. What Would You Do? What Would You Not Do?
  1638. Case Study 3
  1639. Items Included on the Sterile Field
  1640. Procedure: Cervical Punch Biopsy
  1641. Postoperative Instructions: Cervical Punch Biopsy
  1642. Figure 10-31 Cervical punch biopsy. A, Obtaining a tissue specimen from the cervix using cervical biopsy punch forceps. B, Cervical biopsy punch forceps.
  1643. Cryosurgery
  1644. Cervical Cryosurgery
  1645. Cryosurgery Setup
  1646. Items Placed to the Side of the Sterile Field
  1647. Figure 10-32 Cryosurgery unit.
  1648. Items Included on the Sterile Field
  1649. Procedure: Cervical Cryosurgery
  1650. Postoperative Instructions: Cervical Cryosurgery
  1651. Skin Lesions
  1652. Bandaging
  1653. Guidelines for Application
  1654. Types of Bandages
  1655. Bandage Turns
  1656. Figure 10-33 Procedure for anchoring a bandage.
  1657. Figure 10-34 Procedure for making the spiral turn.
  1658. Tubular Gauze Bandages
  1659. 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.
  1660. Figure 10-36 Procedure for applying an elastic bandage around the ankle using a figure-eight turn.
  1661. Figure 10-37 Procedure for using the recurrent turn to bandage the end of a stump.
  1662. Table 10-1 Tubular Gauze Bandage Widths and Recommended Application Sites
  1663. Procedure 10-8  Applying a Tubular Gauze Bandage
  1664. Outcome
  1665. Equipment/Supplies:
  1666. Assemble the equipment.
  1667. Slide the gauze over one end of the applicator.
  1668. Place the applicator over the patient’s finger.
  1669. Move the applicator from the proximal to the distal end of the patient’s finger.
  1670. Rotate the applicator one full turn.
  1671. Cut unused gauze from the applicator.
  1672. Medical Practice and the Law
  1673. What Would You Do? What Would You Not Do?: Responses
  1674. Case Study 1
  1675. What Did Trudy Do?
  1676. What Did Trudy Not Do?
  1677. Case Study 2
  1678. What Did Trudy Do?
  1679. What Did Trudy Not Do?
  1680. Case Study 3
  1681. What Did Trudy Do?
  1682. What Did Trudy Not Do?
  1683.  Certification Review
  1684.  Terminology Review
  1685.  On The Web
  1686. Chapter 11 Administration of Medication and Intravenous Therapy
  1687. Key Terms
  1688. Introduction to the Administration of Medication
  1689. Administering, Prescribing, and Dispensing Medication
  1690. Legal Aspects
  1691. Routes of Administration
  1692. Drug References
  1693. Food and Drug Administration
  1694. Drug Nomenclature
  1695. Figure 11-1 Guidelines for using the Physician’s Desk Reference.
  1696. What Would You Do? What Would You Not Do?
  1697. Case Study 1
  1698. Classification of Drugs Based on Preparation
  1699. Liquid Preparations
  1700. Solid Preparations
  1701. Classification of Drugs Based on Action
  1702. Table 11-1 Classification of Drugs Based on Action
  1703. Systems of Measurement for Medication
  1704. Metric System
  1705. Apothecary System
  1706. Household System
  1707. Converting Units of Measurement
  1708. Metric Notation Guidelines
  1709. Metric System: Conversion of Equivalent Values
  1710. Weight
  1711. Volume
  1712. Table 11-2 Household System: Conversion of Common Values
  1713. Table 11-3 Conversion Charts for Systems of Measurement
  1714. Controlled Drugs
  1715. Putting It All into Practice
  1716. Prescription
  1717. Apothecary Notation Guidelines
  1718. Apothecary System: Conversion of Equivalent Values
  1719. Weight
  1720. Volume
  1721. Parts of a Prescription
  1722. Table 11-4 Classification of Controlled Drugs
  1723. Table 11-5 Common Abbreviations and Symbols Used in Medication Documentation
  1724. Generic Prescribing
  1725. Figure 11-2 Example of a hand-written prescription.
  1726. Completing a Prescription Form
  1727. EMR Prescription Program
  1728. Guidelines for Completing a Prescription Form
  1729. Medication Record
  1730. Patient Teaching: Prescription Medications
  1731. What Would You Do? What Would You Not Do?
  1732. Case Study 2
  1733. Figure 11-3 Example of a computer-generated prescription.
  1734. Figure 11-4 Example of a computer-generated patient medication list.
  1735. Figure 11-5 Example of a medication record.
  1736. Factors Affecting Drug Action
  1737. Therapeutic Effect
  1738. Age
  1739. Route of Administration
  1740. Size
  1741. Time of Administration
  1742. Tolerance
  1743. Memories from Practicum
  1744. Undesirable Effects of Drugs
  1745. Adverse Reactions
  1746. Drug Interactions
  1747. Allergic Drug Reaction
  1748. Idiosyncratic Reaction
  1749. Guidelines for Preparation and Administration of Medication
  1750. Oral Administration
  1751. Procedure 11-1  Administering Oral Medication
  1752. Outcome
  1753. Equipment/Supplies:
  1754. Compare the medication with the physician’s instructions.
  1755. Pour the correct number of capsules or tablets into the bottle cap.
  1756. Place the lid of the bottle on a flat surface with the open end facing up.
  1757. Hold the cup at eye level, and pour the medication.
  1758. Parenteral Administration
  1759. Figure 11-6 Diagram of a needle and a 3-mL syringe, with parts identified.
  1760. Parts of a Needle and Syringe
  1761. Needle
  1762. Figure 11-7 Needle lengths and gauges.
  1763. Syringe
  1764. Figure 11-8 Examples of syringe and needle packages labeled according to contents.
  1765. Safety-Engineered Syringes
  1766. Figure 11-9 Various syringes used to administer injections. A, Hypodermic. B, Insulin (U-100). C, Tuberculin.
  1767. Preparation of Parenteral Medication
  1768. Vials
  1769. Ampules
  1770. Prefilled Syringes
  1771. Storage
  1772. Reconstitution of Powdered Drugs
  1773. 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.
  1774. Subcutaneous Injections
  1775. 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.
  1776. Figure 11-12 Information included on the label of a medication vial.
  1777. Figure 11-13 Filter needle used to withdraw medication from an ampule.
  1778. Figure 11-14 A prefilled disposable syringe of medication.
  1779. 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.
  1780. Intramuscular Injections
  1781. Figure 11-16 Angle of insertion for intradermal, subcutaneous, and intramuscular injections.
  1782. 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.
  1783. Intramuscular Injection Sites
  1784. Dorsogluteal Site
  1785. Deltoid Site
  1786. Figure 11-18 Sites of intramuscular injections. A, Dorsogluteal muscle. B, Deltoid muscle. C, Vastus lateralis. D, Ventrogluteal muscle.
  1787. Vastus Lateralis Site
  1788. Ventrogluteal Site
  1789. Figure 11-19 Location of the deltoid site.
  1790. Z-Track Method
  1791. What Would You Do? What Would You Not Do?
  1792. Case Study 3
  1793. 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.
  1794.  Procedure 11-2  Preparing an Injection
  1795. Outcome
  1796. Equipment/Supplies:
  1797. Compare the medication with the physician’s instructions.
  1798. Check the drug label three times.
  1799. Check the expiration date.
  1800. Check the package insert.
  1801. Withdrawing Medication From a Vial
  1802. Cleanse the rubber stopper.
  1803. Draw air into the syringe.
  1804. Inject air into the vial.
  1805. Withdraw the proper amount of medication.
  1806. Tap the barrel with the fingertips to remove air bubbles.
  1807. Withdrawing Medication From an Ampule
  1808. Snap off the stem away from the body.
  1809. Withdraw the medication.
  1810.  Procedure 11-3  Reconstituting Powdered Drugs
  1811. Outcome
  1812. Equipment/Supplies:
  1813. Inject the diluent into the vial.
  1814. Roll the vial between the hands.
  1815.  Procedure 11-4  Administering a Subcutaneous Injection
  1816. Outcome
  1817. Equipment/Supplies:
  1818. Cleanse the area with an antiseptic wipe.
  1819. Grasp the area surrounding the injection site.
  1820. Insert the needle at a 45-degree angle.
  1821. Pull back gently to determine whether the needle is in a blood vessel.
  1822.  Procedure 11-5  Administering an Intramuscular Injection
  1823. Outcome
  1824. Equipment/Supplies:
  1825. Cleanse the site with an antiseptic wipe.
  1826. A-B, Insert the needle at a 90-degree angle.
  1827. Aspirate to determine whether the needle is in a blood vessel.
  1828. A-B, Inject the medication slowly and steadily.
  1829. Apply gentle pressure to the injection site.
  1830.  Procedure 11-6  Z-Track Intramuscular Injection Technique
  1831. Outcome
  1832. Equipment/Supplies:
  1833. Intradermal Injections
  1834. Figure 11-21 Intradermal injections are used to administer skin tests. Enough medication must be deposited in the skin layers to form a wheal.
  1835. Tuberculin Skin Testing
  1836. Tuberculosis
  1837. Purpose of Tuberculin Skin Testing
  1838. Table 11-6 Differences Between Active TB and Latent TB
  1839. Tuberculin Skin Test Reactions
  1840. Mantoux Tuberculin Skin Test
  1841. Figure 11-22 Positive tuberculin skin test.
  1842. Highlight on Tuberculosis
  1843. What Part of the Body Becomes Infected?
  1844. Is TB Contagious?
  1845. Who is at Risk for TB?
  1846. How is TB Treated?
  1847. Is There a Vaccine for Tuberculosis?
  1848. Is TB a Reportable Disease?
  1849. Guidelines for Administering a Mantoux TST
  1850. Guidelines for Reading Mantoux TST Results
  1851. Figure 11-23 Positive tuberculin skin test showing induration and erythema. Induration is the only criterion used to determine a positive reaction.
  1852. Table 11-7 Interpretation of the Tuberculin Mantoux Skin Test*
  1853. Two-Step Tuberculin Skin Test
  1854. Tuberculosis Blood Test
  1855. Figure 11-24 Interpretation of the two-step Mantoux tuberculin skin test.
  1856. Allergy Testing
  1857. Allergy
  1858. Allergic Reaction
  1859. Diagnosis and Treatment
  1860. Table 11-8 Clinical Forms of Allergies
  1861. Types of Allergy Tests
  1862. Direct Skin Testing
  1863. Quality Control
  1864. Types of Direct Skin Tests
  1865. Patch Testing
  1866. Highlight on Allergens
  1867. House Dust
  1868. Insect Stings
  1869. Penicillin
  1870. 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.
  1871. Skin-Prick Testing
  1872. Figure 11-26 Patch test showing positive results.
  1873. Table 11-9 Guidelines for Recording Direct Skin Test Results
  1874. 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.
  1875. 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.
  1876. Intradermal Skin Testing
  1877. Figure 11-29 Skin-prick and intradermal skin test results.
  1878. In Vitro Allergy Blood Testing
  1879.  Procedure 11-7  Administering an Intradermal Injection
  1880. Outcome
  1881. Equipment/Supplies:
  1882. Insert the needle at a 10- to 15-degree angle with the bevel upward.
  1883. Inject the medication to form a wheal.
  1884. Properly dispose of the needle and syringe.
  1885. Equipment/Supplies:
  1886. Lightly palpate for induration.
  1887. Measure the induration.
  1888. Intravenous Therapy
  1889. Advantages of Outpatient Intravenous Therapy
  1890. Figure 11-30 IV therapy.
  1891. Figure 11-31 Patient receiving IV therapy in an outpatient setting.
  1892. Earlier Hospital Discharge
  1893. Avoidance of Hospitalization
  1894. Medical Office–Based Intravenous Therapy
  1895. Indications for Outpatient Intravenous Therapy
  1896. Scheduling the IV Therapy
  1897. Medical Office Guidelines
  1898. Medical Practice and the Law
  1899. What Would You Do? What Would You Not Do?: Responses
  1900. Case Study 1
  1901. What Did Theresa Do?
  1902. What Did Theresa Not Do?
  1903. Case Study 2
  1904. What Did Theresa Do?
  1905. What Did Theresa Not Do?
  1906. Case Study 3
  1907. What Did Theresa Do?
  1908. What Did Theresa Not Do?
  1909.  Certification Review
  1910.  Terminology Review
  1911.  On The Web
  1912. Chapter 12 Cardiopulmonary Procedures
  1913. Key Terms
  1914. Introduction to Electrocardiography
  1915. Structure of the Heart
  1916. Figure 12-1 A three-channel electrocardiograph.
  1917. Conduction System of the Heart
  1918. Figure 12-2 Diagram of the heart.
  1919. Figure 12-3 Coronary arteries.
  1920. Putting it All into Practice
  1921. Cardiac Cycle
  1922. Figure 12-4 Diagram of the heart, identifying the structures involved with the conduction of an electrical impulse through the heart.
  1923. Waves
  1924. Figure 12-5 ECG cycle.
  1925. Baseline, Segments, and Intervals
  1926. Segments
  1927. Intervals
  1928. Electrocardiograph Paper
  1929. Figure 12-6 Diagram of ECG paper with a section enlarged to indicate the sizes of the large and small squares.
  1930. Standardization of the Electrocardiograph
  1931. Figure 12-7 Standardization mark.
  1932. Electrocardiograph Leads
  1933. Electrodes
  1934. 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.
  1935. 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.
  1936. Bipolar Leads
  1937. Augmented Leads
  1938. Chest Leads
  1939. Figure 12-10 Diagram of the heart’s voltage for leads I, II, III, aVR, aVL, and aVF.
  1940. Highlight on Cardiac Stress Testing
  1941. Description
  1942. Purpose
  1943. Patient Preparation
  1944. How the Test Works
  1945. Interpretation of Results
  1946. Cardiac treadmill stress test.
  1947. Paper Speed
  1948. What Would You Do? What Would You Not Do?
  1949. Case Study 1
  1950. 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
  1951. Patient Preparation
  1952. Maintenance of the Electrocardiograph
  1953. Electrocardiographic Capabilities
  1954. Three-Channel Recording Capability
  1955. Interpretive Electrocardiograph
  1956. Figure 12-12 A three-channel ECG with a rhythm strip.
  1957. EMR Connectivity
  1958. Teletransmission
  1959. Artifacts
  1960. 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.
  1961. Muscle Artifact
  1962. Figure 12-14 A-D, Examples of ECG artifacts.
  1963. Wandering Baseline Artifact
  1964. 60-Cycle Interference Artifact
  1965. Interrupted Baseline Artifact
  1966.  Procedure 12-1  Running a 12-Lead, Three-Channel Electrocardiogram
  1967. Outcome
  1968. Equipment/Supplies:
  1969. Apply the leg electrodes.
  1970. Apply the arm electrodes.
  1971. Apply the chest electrodes.
  1972. Connect the lead wires to the electrodes.
  1973. Enter patient data.
  1974. Check the standardization mark.
  1975. Holter Monitor Electrocardiography
  1976. Figure 12-15 Digital Holter monitor.
  1977. Purpose
  1978. Digital Holter Monitor
  1979. Patient Preparation
  1980. Memories from Practicum
  1981. Electrode Placement
  1982. Figure 12-16 A, Diagram of an electrode used with a Holter monitor. B, Holter monitor electrode (front and back).
  1983. Figure 12-17 Holter monitor patient diary.
  1984. Patient Diary
  1985. Event Marker
  1986. Holter Monitor Patient Guidelines
  1987. Evaluating Results
  1988. Maintenance of the Holter Monitor
  1989. Procedure 12-2  Applying a Holter Monitor
  1990. Outcome
  1991. Equipment/Supplies:
  1992. Assemble the equipment.
  1993. Insert the battery.
  1994. Shave the chest.
  1995. Rub the skin with an alcohol wipe.
  1996. Slightly abrade the skin with a skin abrader.
  1997. Snap the color-coded lead wires onto the electrodes.
  1998. Ensure a firm seal of each electrode.
  1999. Insert the monitor into a disposable pouch.
  2000. Provide the patient with instructions on completion of the diary.
  2001. Cardiac Dysrhythmias
  2002. Premature Atrial Contraction
  2003. Description
  2004. Premature atrial contraction.
  2005. Clinical Significance
  2006. Paroxysmal Atrial Tachycardia
  2007. Description
  2008. Clinical Significance
  2009. Paroxysmal atrial tachycardia.
  2010. Patient Teaching: Angina Pectoris
  2011. What is Angina Pectoris?
  2012. What Causes Angina Pectoris?
  2013. What Happens During an Angina Episode?
  2014. What Tests Might be Ordered by the Physician?
  2015. What Type of Treatment Might be Prescribed by the Physician?
  2016. Atrial Flutter
  2017. Description
  2018. Clinical Significance
  2019. Atrial flutter.
  2020. Atrial Fibrillation
  2021. Description
  2022. Clinical Significance
  2023. Atrial fibrillation.
  2024. Premature Ventricular Contraction
  2025. Description
  2026. Clinical Significance
  2027. Premature ventricular contraction.
  2028. Ventricular Tachycardia
  2029. Description
  2030. Clinical Significance
  2031. Ventricular tachycardia.
  2032. Ventricular Fibrillation
  2033. Description
  2034. Clinical Significance
  2035. Ventricular fibrillation.
  2036. Pulmonary Function Tests
  2037. Spirometry
  2038. Spirometry Test Results
  2039. Forced Vital Capacity
  2040. Forced Expiratory Volume after 1 Second
  2041. FEV1  /FVC Ratio
  2042. What Would You Do? What Would You Not Do?
  2043. Case Study 2
  2044. Evaluation of Results
  2045. Figure 12-18 Spirometry parameters.
  2046. Figure 12-19 Predicted values compared with measured values. This individual exhibits a moderate airflow obstruction.
  2047. Patient Preparation
  2048. Calibration of the Spirometer
  2049. Post-Bronchodilator Spirometry
  2050. What Would You Do? What Would You Not Do?
  2051. Case Study 3
  2052. Highlight on Smoking and Chronic Obstructive Pulmonary Disease
  2053. COPD Defined
  2054. Emphysema
  2055. Emphysema caused by smoking.
  2056. Chronic Bronchitis
  2057. Symptoms of COPD
  2058. Treatment for COPD
  2059.  Procedure 12-3  Spirometry Testing
  2060. Outcome
  2061. Equipment/Supplies:
  2062. Instruct the patient to blow into the mouthpiece.
  2063. Figure 12-20 The primary bronchi divide into secondary and tertiary bronchi and then into smaller passages known as bronchioles.
  2064. Peak Flow Measurement
  2065. Asthma
  2066. Asthma Attack
  2067. Figure 12-21 A, Normal bronchial tube. B, Bronchial tube during an asthma attack.
  2068. Diagnosis and Treatment
  2069. Figure 12-22 An inhaler is often used to deliver asthma medication to the bronchial tubes of the lungs.
  2070. Peak Flow Meter
  2071. Figure 12-23 Manual peak flow meter.
  2072. Figure 12-24 Digital peak flow meter.
  2073. Figure 12-25 Comparison of a low-range (A, B: left) and full-range (A, B: right) peak flow meter.
  2074. Peak Flow Rate
  2075. Schedule of Use
  2076. Purpose of Peak Flow Measurements
  2077. Figure 12-26 An example of a peak flow chart.
  2078. Care and Maintenance
  2079.  Procedure 12-4  Measuring Peak Flow Rate
  2080. Outcome
  2081. Equipment/Supplies:
  2082. Move indicator to bottom of scale.
  2083. Apply a disposable mouthpiece.
  2084. The patient takes a deep breath.
  2085. The patient blows out hard and fast.
  2086. Note where the indicator stopped on the scale.
  2087. Home Oxygen Therapy
  2088. Oxygen Prescription
  2089. Oxygen Delivery Systems
  2090. Compressed Oxygen Gas
  2091. Figure 12-27 A, Compressed oxygen cylinders. B, Oxygen cylinder with regulator and flow meter attached.
  2092. Advantage
  2093. Disadvantages
  2094. Liquid Oxygen
  2095. Figure 12-28 Liquid oxygen tank (stationary tank and portable tank).
  2096. Advantage
  2097. Disadvantages
  2098. Oxygen Concentrator
  2099. Figure 12-29 A, Stationary oxygen concentrator. B, Portable oxygen concentrator.
  2100. Advantages
  2101. Disadvantage
  2102. Oxygen Administration Devices
  2103. Nasal Cannula
  2104. Face Mask
  2105. 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.
  2106. Oxygen Guidelines
  2107. Usage
  2108. Figure 12-31 Face mask.
  2109. Safety
  2110. Medical Practice and the Law
  2111. What Would You Do? What Would You Not Do?: Responses
  2112. Case Study 1
  2113. What Did Janet Do?
  2114. What Did Janet Not Do?
  2115. Case Study 2
  2116. What Did Janet Do?
  2117. What Did Janet Not Do?
  2118. Case Study 3
  2119. What Did Janet Do?
  2120. What Did Janet Not Do?
  2121.  Certification Review
  2122.  Terminology Review
  2123.  On The Web
  2124. Chapter 13 Colon Procedures and Male Reproductive Health
  2125. Key Terms
  2126. Introduction to Colon Procedures
  2127. Structure of the Large Intestine
  2128. Blood in the Stool
  2129. Fecal Occult Blood Test
  2130. Guaiac Slide Test
  2131. Figure 13-1 Large intestine.
  2132. Figure 13-2 Examples of fecal occult blood testing kits. Hemoccult (top) and ColoScreen (bottom).
  2133. Purpose
  2134. Patient Preparation
  2135. Quality Control
  2136. Putting It All into Practice
  2137. Table 13-1 Patient Preparation for the Fecal Occult Guaiac Slide Test
  2138. What Would You Do? What Would You Not Do?
  2139. Case Study 1
  2140. Highlight on Colorectal Cancer
  2141. Incidence
  2142. Risk Factors
  2143. Colon cancer.
  2144. Symptoms
  2145. Recommendations for Early Detection
  2146. Cause
  2147. Other Types of Stool Tests
  2148. Fecal Immunochemical Test
  2149. Figure 13-3 Fecal immunochemical tests: QuickVue iFOB (left) Hemoccult ICT (right).
  2150. Fecal DNA Test
  2151.  Procedure 13-1  Fecal Occult Blood Testing: Guaiac Slide Test
  2152. Outcome
  2153. Equipment/Supplies:
  2154. Check the expiration date.
  2155. Each slide contains two squares labeled “A” and “B.”
  2156. Instruct the patient on how to complete the information section on the slides.
  2157. Spread a thin smear of the specimen over the filter paper.
  2158. Place the cardboard slides in the envelope.
  2159.  Procedure 13-2  Developing the Hemoccult Slide Test
  2160. Outcome
  2161. Equipment/Supplies:
  2162. Apply 2 drops of developing solution.
  2163. Apply 1 drop of developing solution to the control area.
  2164. The positive area should turn blue, and the negative area should show no color change.
  2165. Sigmoidoscopy
  2166. Purpose
  2167. Figure 13-4 Sigmoidoscopy and colonoscopy.
  2168. Patient Preparation for Sigmoidoscopy
  2169. Digital Rectal Examination
  2170. Sigmoidoscope
  2171. Procedure
  2172. Table 13-2 Patient Preparation for Sigmoidoscopy
  2173. Figure 13-5 Flexible fiberoptic sigmoidoscope.
  2174. What Would You Do? What Would You Not Do?
  2175. Case Study 2
  2176. Colonoscopy
  2177. Purpose
  2178. Patient Preparation for Colonoscopy
  2179. Figure 13-6 Colon polyp.
  2180. Procedure
  2181. Table 13-3 Patient Preparation for Colonoscopy
  2182. Procedure 13-3  Assisting With a Sigmoidoscopy
  2183. Outcome
  2184. Equipment/Supplies:
  2185. Assemble the equipment.
  2186. Place lubricant on the sigmoidoscope.
  2187. Hold the specimen container to accept the biopsy specimen.
  2188. Introduction to Male Reproductive Health
  2189. Prostate Cancer
  2190. Figure 13-7 Digital rectal examination.
  2191. Prostate Cancer Screening
  2192. Digital Rectal Examination
  2193. Prostate-Specific Antigen Test
  2194. Recommendations for Prostate Screening
  2195. What Would You Do? What Would You Not Do?
  2196. Case Study 3
  2197. Testicular Self-Examination
  2198. Figure 13-8 Testicular self-examination.
  2199. Memories of Practicum
  2200. Medical Practice and the Law
  2201. Malpractice
  2202. What Would You Do? What Would You Not Do?: Responses
  2203. Case Study 1
  2204. What Did Megan Do?
  2205. What Did Megan Not Do?
  2206. Case Study 2
  2207. What Did Megan Do?
  2208. What Did Megan Not Do?
  2209. Case Study 3
  2210. What Did Megan Do?
  2211. What Did Megan Not Do?
  2212.  Certification Review
  2213.  Terminology Review
  2214.  On the Web
  2215. Chapter 14 Radiology and Diagnostic Imaging
  2216. Key Terms
  2217. Introduction to Radiology
  2218. Contrast Media
  2219. Figure 14-1 Posteroanterior view of the chest. Position of patient and radiograph.
  2220. What Would You Do? What Would You Not Do?
  2221. Case Study 1
  2222. Fluoroscopy
  2223. Positioning the Patient
  2224. Specific Radiographic Examinations
  2225. Mammography
  2226. Putting It All into Practice
  2227. Figure 14-2 Michelle instructs a patient in proper preparation for a radiographic examination.
  2228. Figure 14-3 Patient positioning for mammography.
  2229. Bone Density Scan
  2230. Figure 14-4 Mammogram. Arrows indicate suspicious area of increased density that needs further evaluation.
  2231. Gastrointestinal Series
  2232. Upper Gastrointestinal Radiography
  2233. Patient Teaching: Mammography
  2234. What is the Purpose of Mammography?
  2235. Who Should Have a Mammogram?
  2236. What Occurs During the Mammography Procedure?
  2237. Does Mammography Take the Place of Breast Self-Examination?
  2238. Lower Gastrointestinal Radiography
  2239. Figure 14-5 Lower GI. Colon is distended with barium. Positioning of patient and radiograph.
  2240. Intravenous Pyelography
  2241. Figure 14-6 Intravenous pyelogram obtained 15 minutes after intravenous injection of a suitable contrast agent.
  2242. Other Types of Radiographs
  2243. Introduction to Diagnostic Imaging
  2244. Ultrasonography
  2245. Figure 14-7 3-D ultrasound of a third-trimester fetus.
  2246. Figure 14-8 Sonogram of the right kidney.
  2247. Patient Preparation
  2248. What Would You Do? What Would You Not Do?
  2249. Case Study 2
  2250. Computed Tomography
  2251. Figure 14-9 Positioning patient for computed tomography (CT) scan.
  2252. Patient Preparation
  2253. 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.
  2254. Magnetic Resonance Imaging
  2255. Memories of Practicum
  2256. Patient Preparation
  2257. What Would You Do? What Would You Not Do?
  2258. Case Study 3
  2259. 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.
  2260. Nuclear Medicine
  2261. Bone Scans
  2262. Nuclear Cardiac Stress Test
  2263. Figure 14-12 Bone scan of the foot. Arrows show the hot spot that indicates a stress fracture.
  2264. Figure 14-13 Digital image of a chest x-ray. (Screenshot used by permission of MCKESSON Corporation. All rights reserved. © MCKESSON Corporation, 2011.)
  2265. Guidelines
  2266. Digital Radiology
  2267. Medical Practice and the Law
  2268. What Would You Do? What Would You Not Do?: Responses
  2269. Case Study 1
  2270. What Did Michelle Do?
  2271. What Did Michelle Not Do?
  2272. Case Study 2
  2273. What Did Michelle Do?
  2274. What Did Michelle Not Do?
  2275. Case Study 3
  2276. What Did Michelle Do?
  2277. What Did Michelle Not Do?
  2278.  Certification Review
  2279.  Terminology Review
  2280.  On the Web
  2281. Chapter 15 Introduction to the Clinical Laboratory
  2282. Key Terms
  2283. Introduction to the Clinical Laboratory
  2284. Laboratory Tests
  2285. Purpose of Laboratory Testing
  2286. Table 15-1 Categories of Laboratory Tests*
  2287. Types of Clinical Laboratories
  2288. Physician’s Office Laboratory
  2289. Figure 15-1 Urinalysis is frequently performed in a physician’s office laboratory (POL).
  2290. Physical Structure of the POL
  2291. Figure 15-2 Eyewash station.
  2292. Outside Laboratories
  2293. Figure 15-3 Laboratory directory.
  2294. Laboratory Directory
  2295. Collection and Testing Categories
  2296. Table 15-2 Representative Tests From a (Modified) Laboratory Directory
  2297. Laboratory Requests
  2298. Purpose
  2299. Parts of the Laboratory Request Form
  2300. Figure 15-4 Laboratory request form.
  2301. Table 15-3 Laboratory Profiles
  2302. What Would You Do? What Would You Not Do?
  2303. Case Study 1
  2304. Putting It All into Practice
  2305. Laboratory Reports
  2306. Figure 15-5 Laboratory report form.
  2307. Figure 15-6 Computer-generated laboratory report.
  2308. Laboratory Documents and the EMR
  2309. Figure 15-7 Cholesterol flow sheet generated by a computer. (Screenshot used by permission of MCKESSON Corporation. All rights reserved. © MCKESSON Corporation, 2011.)
  2310. Patient Preparation and Instructions
  2311. What Would You Do? What Would You Not Do?
  2312. Case Study 2
  2313. Fasting
  2314. Figure 15-8 Oral glucose tolerance test patient instruction sheet.
  2315. Medication Restrictions
  2316. What Would You Do? What Would You Not Do?
  2317. Case Study 3
  2318. Collecting, Handling, and Transporting Specimens
  2319. Guidelines for Specimen Collection
  2320. Figure 15-9 Collection and handling requirements for a triglyceride test from a laboratory directory.
  2321. Figure 15-10 Blood tube showing expiration date.
  2322. Figure 15-11 A, Computerized bar code label. B, Hand-labeled blood tube.
  2323. Figure 15-12 Medical and surgical asepsis must be used when collecting a specimen.
  2324. Figure 15-13 Serum specimen in a serum separator tube (SST) that has been centrifuged.
  2325. Figure 15-14 Biohazard specimen bag containing a specimen and laboratory request form.
  2326. Table 15-4 Handling and Storage of Biologic Specimens*
  2327. Procedure 15-1  Collecting a Specimen for Transport to an Outside Laboratory
  2328. Outcome
  2329. Instruct the patient on advance preparation.
  2330. Label the tubes.
  2331. Collect the specimen.
  2332. Centrifuge the specimen.
  2333. Prepare the specimen for transport.
  2334. Clinical Laboratory Improvement Amendments
  2335. Purpose of CLIA 1988
  2336. Categories of Laboratory Testing
  2337. Requirements for Moderate-Complexity and High-Complexity Testing
  2338. Memories of Practicum
  2339. CLIA-Waived Laboratory Testing
  2340. CLIA-Waived Testing Kits
  2341. Figure 15-15 CLIA-waived testing kits.
  2342. Table 15-5 Information Included in the Product Insert of a Testing Kit
  2343. Figure 15-16 Unitized testing device.
  2344. CLIA-Waived Automated Analyzers
  2345. Figure 15-17 Digital readout of results on an automated analyzer.
  2346. Quality Control
  2347. Figure 15-18 Clinical Laboratories Improvement Amendments (CLIA)-waived automated analyzers. Blood cholesterol analyzer (left) and hemoglobin analyzer (right).
  2348. Figure 15-19 A, Calibrating an automated analyzer using a calibration device. B, Calibration results are compared with expected results on the calibration device.
  2349. Figure 15-20 Internal control. The blue line next to the letter “C” indicates that the internal control has reacted as expected.
  2350. Figure 15-21 External controls. Low or level 1 control (left) and high or level 2 control (right).
  2351. Figure 15-22 Quality control log sheet for blood glucose testing.
  2352. Figure 15-23 Color diagram used to interpret test results.
  2353. Categories of Test Results
  2354. Qualitative Test Results
  2355. Quantitative Test Results
  2356. Recording Test Results
  2357. Laboratory Safety
  2358. Figure 15-24 Patient log of laboratory tests.
  2359. Medical Practice and the Law
  2360. What Would You Do? What Would You Not Do?: Responses
  2361. Case Study 1
  2362. What Did Korey Do?
  2363. What Did Korey Not Do?
  2364. Case Study 2
  2365. What Did Korey Do?
  2366. What Did Korey Not Do?
  2367. Case Study 3
  2368. What Did Korey Do?
  2369. What Did Korey Not Do?
  2370.  Certification Review
  2371.  Terminology Review
  2372.  On the Web
  2373. Chapter 16 Urinalysis
  2374. Key Terms
  2375. Structure and Function of the Urinary System
  2376. Composition of Urine
  2377. Terms Related to the Urinary System
  2378. Collection of Urine
  2379. Figure 16-1 Structures that make up the urinary system.
  2380. Guidelines for Urine Collection
  2381. Figure 16-2 Nephron.
  2382. Urine Specimen Collection Methods
  2383. What Would You Do? What Would You Not Do?
  2384. Case Study 1
  2385. Random Specimen
  2386. First-Voided Morning Specimen
  2387. Clean-Catch Midstream Specimen
  2388. Guidelines
  2389. Figure 16-3 Urinalysis laboratory request form.
  2390. Twenty-Four–Hour Urine Specimen
  2391.  Procedure 16-1  Clean-Catch Midstream Specimen Collection Instructions
  2392. Outcome
  2393. Equipment/Supplies:
  2394. Assemble the equipment.
  2395. Procedure 16-2  Collection of a 24-Hour Urine Specimen
  2396. Outcome
  2397. Equipment/Supplies:
  2398. Assemble the equipment.
  2399. Explain the procedure.
  2400. Analysis of Urine
  2401. Physical Examination of Urine
  2402. Color
  2403. Figure 16-4 Color of urine.
  2404. Figure 16-5 Appearance of urine.
  2405. Appearance
  2406. Odor
  2407. Specific Gravity
  2408. Chemical Examination of Urine
  2409. Urine Testing Kits
  2410. Table 16-1 Diagnostic Kits Used for Chemical Testing of Urine
  2411. What Would You Do? What Would You Not Do?
  2412. Case Study 2
  2413. Putting It All into Practice
  2414. pH
  2415. Glucose
  2416. Protein
  2417. Ketone
  2418. Bilirubin
  2419. Urobilinogen
  2420. Highlight on Drug Testing in the Workplace
  2421. Statistics
  2422. Testing Programs
  2423. Testing Methods
  2424. Chain of Custody
  2425. Disadvantages
  2426. Intervention
  2427. Blood
  2428. Nitrite
  2429. Leukocytes
  2430. Reagent Strips
  2431. Guidelines for Reagent Strip Urine Testing
  2432. Quality Control Testing
  2433. Table 16-2 Urine Test Strip Parameters and the Diagnoses They Assist*
  2434. Urine Analyzer
  2435. Figure 16-6 Chek-Stix control strips.
  2436. Figure 16-7 A, Clinitek Urine Analyzer. B, Clinitek printout.
  2437.  Procedure 16-3  Chemical Testing of Urine With the Multistix 10 SG Reagent Strip
  2438. Outcome
  2439. Equipment/Supplies:
  2440. Completely immerse the reagent strip in the urine.
  2441. Run the edge of the strip against the urine container.
  2442. Hold the strip horizontally and read the results.
  2443. Microscopic Examination of Urine
  2444. Red Blood Cells
  2445. Memories of Practicum
  2446. Patient Teaching: Urinary Tract Infections
  2447. What is a UTI?
  2448. What are the symptoms of a UTI?
  2449. Why do women have UTIs more frequently than men?
  2450. What can women do to prevent a UTI?
  2451. Table 16-3 Cells in Urine Sediment
  2452. Table 16-4 Casts in Urine Sediment
  2453. Table 16-5 Urine Crystals
  2454. Table 16-6 Microorganisms and Artifacts in the Urine
  2455. White Blood Cells
  2456. Epithelial Cells
  2457. Casts
  2458. Crystals
  2459. Miscellaneous Structures
  2460. Procedure 16-4  Prepare a Urine Specimen for Microscopic Examination: Kova Method
  2461. Outcome
  2462. Equipment/Supplies:
  2463. Preparing the Specimen
  2464. Assemble the equipment.
  2465. Pour the specimen into the urine tube.
  2466. Centrifuge the specimen.
  2467. Insert the pipet until it seats firmly.
  2468. Pour the supernatant fluid.
  2469. Mix the sediment and stain.
  2470. Fill the well with the specimen.
  2471. Focus the specimen for the physician.
  2472. Rapid Urine Cultures
  2473. Urine Pregnancy Testing
  2474. Human Chorionic Gonadotropin
  2475. Immunoassay Tests
  2476. Guidelines for Urine Pregnancy Testing
  2477. Serum Pregnancy Test
  2478. Figure 16-8 Quality control log for urine pregnancy testing.
  2479. What Would You Do? What Would You Not Do?
  2480. Case Study 3
  2481. Procedure 16-5  Performing a Rapid Urine Culture Test
  2482. Outcome
  2483. Equipment/Supplies:
  2484. Preparing the Specimen
  2485. Assemble the equipment.
  2486. Dip the slide into the urine specimen.
  2487. Incubate the specimen.
  2488. Reading Test Results
  2489. Compare the slide with the reference chart.
  2490.  Procedure 16-6  Performing a Urine Pregnancy Test
  2491. Outcome
  2492. Equipment/Supplies:
  2493. Assemble the equipment.
  2494. Add 3 drops of urine to the test well.
  2495. Interpret the results.
  2496. Medical Practice and the Law
  2497. Civil versus Criminal Law
  2498. What Would You Do? What Would You Not Do?: Responses
  2499. Case Study 1
  2500. What Did Linda Do?
  2501. What Did Linda Not Do?
  2502. Case Study 2
  2503. What Did Linda Do?
  2504. What Did Linda Not Do?
  2505. Case Study 3
  2506. What Did Linda Do?
  2507. What Did Linda Not Do?
  2508.  Certification Review
  2509.  Terminology Review
  2510.  On the Web
  2511. Chapter 17 Phlebotomy
  2512. Key Terms
  2513. Introduction to Phlebotomy
  2514. Venipuncture
  2515. Figure 17-1 Specimen in a biohazard specimen bag along with the laboratory request form.
  2516. General Guidelines for Venipuncture
  2517. Patient Preparation for Venipuncture
  2518. Review Collection and Handling Requirements
  2519. Identification of the Patient
  2520. Assemble the Equipment and Supplies
  2521. Figure 17-2 Collection and handling requirements for a complete blood count (CBC) from a laboratory directory.
  2522. Figure 17-3 Blood tube showing expiration date.
  2523. Figure 17-4 A, Computerized bar code label. B, Hand-labeled blood tube.
  2524. Reassuring the Patient
  2525. Figure 17-5 Patient position for obtaining a blood specimen from the antecubital veins.
  2526. Patient Position for Venipuncture
  2527. Application of the Tourniquet
  2528. Guidelines for Applying the Tourniquet
  2529. Putting It All into Practice
  2530. Types of Tourniquets
  2531. Rubber Tourniquet
  2532. Procedure: Rubber Tourniquet
  2533. 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.
  2534. Velcro-Closure Tourniquet
  2535. Figure 17-7 Application of a Velcro-closure tourniquet.
  2536. Procedure: Velcro-Closure Tourniquet
  2537. Site Selection for Venipuncture
  2538. Figure 17-8 Antecubital veins.
  2539. Guidelines for Site Selection
  2540. Alternative Venipuncture Sites
  2541. Types of Blood Specimens
  2542. Figure 17-9 Alternative venipuncture sites: the inner forearm, the wrist area above the thumb, and the back of the hand.
  2543. Figure 17-10 Layers into which the blood separates when there is no anticoagulant (A) and when an anticoagulant is present (B).
  2544. OSHA Safety Precautions
  2545. What Would You Do? What Would You Not Do?
  2546. Case Study 1
  2547. Vacuum Tube Method of Venipuncture
  2548. Needle
  2549. Figure 17-11 Vacuum tube system.
  2550. 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.
  2551. Safety-Engineered Venipuncture Devices
  2552. 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.
  2553. 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.
  2554. Plastic Holder
  2555. Evacuated Tubes
  2556. Figure 17-15 Hemogard tubes.
  2557. Figure 17-16 Evacuated tube package label.
  2558. Additive Content of Evacuated Tubes
  2559. Order of Draw for Multiple Tubes
  2560. Table 17-1 Order of Draw for Collection of Multiple Evacuated Tubes
  2561. What Would You Do? What Would You Not Do?
  2562. Case Study 2
  2563. Evacuated Tube Guidelines
  2564. Figure 17-17 Information included on a laboratory specimen bar code label.
  2565.  Procedure 17-1  Venipuncture—Vacuum Tube Method
  2566. Outcome
  2567. Equipment/Supplies:
  2568. Assemble the equipment.
  2569. Insert the posterior needle into the plastic holder.
  2570. Apply the tourniquet.
  2571. Palpate the vein.
  2572. Rotate the safety shield backward.
  2573. Position the needle.
  2574. Make the puncture.
  2575. Remove the tube from the holder.
  2576. Invert the tube 8 to 10 times.
  2577. Withdraw the needle.
  2578. Figure 17-18 Winged infusion set. A, Luer adapter with evacuated tube. B, Hub adapter with syringe.
  2579. Butterfly Method of Venipuncture
  2580. Guidelines for the Butterfly Method
  2581. 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.
  2582. Figure 17-20 Application of the tourniquet for alternative venipuncture sites.
  2583.  Procedure 17-2  Venipuncture—Butterfly Method
  2584. Outcome
  2585. Equipment/Supplies:
  2586. Assemble the equipment.
  2587. Screw the plastic holder onto the Luer adapter.
  2588. Remove the protective shield from the needle.
  2589. Make the puncture.
  2590. Rest the butterfly wings flat against the patient’s skin.
  2591. Fill the tubes in a downward position.
  2592. Remove the tube from the holder.
  2593. Release the tourniquet and remove the needle.
  2594. Memories of Practicum
  2595. What Would You Do? What Would You Not Do?
  2596. Case Study 3
  2597. Problems Encountered With Venipuncture
  2598. Failure to Obtain Blood
  2599. Figure 17-21 Problems encountered with venipuncture.
  2600. Inappropriate Puncture Sites
  2601. Scarred and Sclerosed Veins
  2602. Rolling Veins
  2603. Collapsing Veins
  2604. Premature Needle Withdrawal
  2605. Hematoma
  2606. Hemolysis
  2607. Fainting
  2608. Obtaining a Serum Specimen
  2609. Serum
  2610. Highlight on Vasovagal Syncope (Fainting)
  2611. Cause and Symptoms
  2612. Treatment
  2613. Prevention
  2614. Tube Selection
  2615. Preparation of the Specimen
  2616. Figure 17-22 A fibrin clot may interfere with adequate collection of serum.
  2617. Removal of Serum
  2618. Serum Separator Tubes
  2619. 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.
  2620. Procedure 17-3  Separating Serum From a Blood Specimen
  2621. Outcome
  2622. Equipment/Supplies:
  2623. Label the tubes.
  2624. Allow the specimen to stand for 30 to 45 minutes.
  2625. Centrifuge the specimen.
  2626. Pipet the serum.
  2627. Examine the serum.
  2628. Obtaining a Plasma Specimen
  2629. Plasma
  2630. Tube Selection
  2631. Preparation and Removal of the Specimen
  2632. Plasma Separator Tube
  2633. Skin Puncture
  2634. Puncture Sites
  2635. Skin Puncture Devices
  2636. Disposable Semiautomatic Lancet
  2637. Reusable Semiautomatic Lancet
  2638. Figure 17-24 A, Surgilance color-coded lancet devices. B, CoaguChek Lancet device. C, Glucolet 2.
  2639. Microcollection Devices
  2640. Capillary Tubes
  2641. Figure 17-25 Microcollection devices.
  2642. Microcollection Tubes
  2643. Guidelines for Performing a Finger Puncture
  2644. Figure 17-26 Recommended sites for a finger puncture.
  2645.  Procedure 17-4  Skin Puncture—Disposable Semiautomatic Lancet Device
  2646. Outcome
  2647. Equipment/Supplies:
  2648. Assemble the equipment.
  2649. Make the puncture.
  2650. Discard the lancet.
  2651. Wipe away the first drop of blood.
  2652. Collect the specimen.
  2653.  Procedure 17-5  Skin Puncture—Reusable Semiautomatic Lancet Device
  2654. Outcome
  2655. Equipment/Supplies:
  2656. Assemble the equipment.
  2657. Push the barrel until it clicks into place.
  2658. Insert the retractable lancet onto the device.
  2659. Remove the plastic post.
  2660. Make the puncture.
  2661. Collect the specimen.
  2662. Medical Practice and the Law
  2663. What Would You Do? What Would You Not Do?: Responses
  2664. Case Study 1
  2665. What Did Dori Do?
  2666. What Did Dori Not Do?
  2667. Case Study 2
  2668. What Did Dori Do?
  2669. What Did Dori Not Do?
  2670. Case Study 3
  2671. What Did Dori Do?
  2672. What Did Dori Not Do?
  2673.  Certification Review
  2674.  Terminology Review
  2675.  On The Web
  2676. Chapter 18 Hematology
  2677. Key Terms
  2678. Introduction to Hematology
  2679. Table 18-1 Common Hematologic Tests
  2680. Components and Functions of Blood
  2681. Erythrocytes
  2682. Leukocytes
  2683. Figure 18-1 Computer-generated laboratory report for a complete blood count (CBC).
  2684. Putting it All into Practice
  2685. Thrombocytes
  2686. Hemoglobin Determination
  2687. Figure 18-2 CLIA-waived hemoglobin analyzer.
  2688. 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.
  2689. Hematocrit
  2690. What Would You Do? What Would You Not Do?
  2691. Case Study 1
  2692. Patient Teaching: Iron-Deficiency Anemia
  2693. What is Anemia?
  2694. What Causes Iron-Deficiency Anemia?
  2695. What Can be Done for Individuals at Risk for Iron-Deficiency Anemia?
  2696. What are the Symptoms of Anemia?
  2697. How is Iron-Deficiency Anemia Treated?
  2698.  Procedure 18-1  Hematocrit
  2699. Outcome
  2700. Equipment/Supplies:
  2701. Fill the capillary tube.
  2702. Seal one end of the tube.
  2703. Place the tube in the centrifuge.
  2704. Align the bottom of the red cell column with the 0 line.
  2705. Read the results.
  2706. White Blood Cell Count
  2707. Figure 18-4 Coulter blood cell counter.
  2708. Red Blood Cell Count
  2709. Red Blood Cell Indices
  2710. MCV: Mean Corpuscular Volume
  2711. MCH: Mean Corpuscular Hemoglobin
  2712. MCHC: Mean Cell Hemoglobin Concentration
  2713. RDW: Red Cell Distribution Width
  2714. White Blood Cell Differential Count
  2715. Automatic Method
  2716. Manual Method
  2717. 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.
  2718. What Would You Do? What Would You Not Do?
  2719. Case Study 2
  2720. Types of White Blood Cells
  2721. Memories of Practicum
  2722. Reference Range
  2723. What Would You Do? What Would You Not Do?
  2724. Case Study 3
  2725.  Procedure 18-2  Preparation of a Blood Smear for a Differential Cell Count
  2726. Outcome
  2727. Equipment/Supplies:
  2728. Hold the spreader slide in front of the drop of blood.
  2729. Move the spreader into the drop of blood.
  2730. Spread the blood across the slide.
  2731. Properly prepared blood smear.
  2732. Improperly prepared blood smears.
  2733. PT/INR
  2734. Purpose
  2735. Collection of the Specimen
  2736. Figure 18-6 Light blue–stoppered tube used to collect a specimen for a PT/INR test.
  2737. Figure 18-7 Specimen collection and handling requirements for a PT/INR test from a laboratory directory.
  2738. Figure 18-8 PT/INR analyzer.
  2739. Performing a PT/INR Test
  2740. Figure 18-9 Patient performing a PT/INR test at home.
  2741. PT/INR Home Testing
  2742. Medical Practice and the Law
  2743. What Would You Do? What Would You Not Do?: Responses
  2744. Case Study 1
  2745. What Did Latisha Do?
  2746. What Did Latisha Not Do?
  2747. Case Study 2
  2748. What Did Latisha Do?
  2749. What Did Latisha Not Do?
  2750. Case Study 3
  2751. What Did Latisha Do?
  2752. What Did Latisha Not Do?
  2753.  Certification Review
  2754.  Terminology Review
  2755.  On The Web
  2756. Chapter 19 Blood Chemistry and Immunology
  2757. Key Terms
  2758. Introduction to Blood Chemistry and Immunology
  2759. Blood Chemistry
  2760. Collection of a Blood Chemistry Specimen
  2761. Automated Blood Chemistry Analyzers
  2762. Table 19-1 Common Blood Chemistry Tests
  2763. Figure 19-1 Most blood chemistry tests are performed on a serum specimen collected in a serum separator tube (SST).
  2764. Figure 19-2 Specimen collection and handling requirements for a comprehensive metabolic profile as presented in a laboratory directory.
  2765. Figure 19-3 Blood chemistry analyzer.
  2766. Quality Control
  2767. 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.
  2768. Calibration
  2769. Controls
  2770. Figure 19-5 Controls come with a product insert, which lists the expected ranges for control results.
  2771. Figure 19-6 The control solution is added to a testing strip.
  2772. Figure 19-7 The control results are compared with the expected results.
  2773. Blood Glucose
  2774. Blood Glucose Testing
  2775. Fasting Blood Glucose Test
  2776. Two-Hour Postprandial Blood Glucose Test
  2777. Putting It All into Practice
  2778. Oral Glucose Tolerance Test
  2779. Testing Requirements
  2780. What Would You Do? What Would You Not Do?
  2781. Case Study 1
  2782. Side Effects
  2783. Interpretation of Results
  2784. Hypoglycemia
  2785. Tests for Management of Diabetes
  2786. Self-Monitoring of Blood Glucose
  2787. Memories of Practicum
  2788. What Would You Do? What Would You Not Do?
  2789. Case Study 2
  2790. Patient Teaching: Diabetes
  2791. What Is Diabetes?
  2792. What Is the Function of Insulin?
  2793. What are the Symptoms of Diabetes?
  2794. What Is the Difference between Type 1 Diabetes and Type 2 Diabetes?
  2795. Type 1 Diabetes
  2796. Insulin pump.
  2797. Type 2 Diabetes
  2798. What Factors Increase the Risk of Developing Type 2 Diabetes?
  2799. Risk Factors That can be Controlled
  2800. Risk Factors that cannot be Controlled
  2801. Can Diabetes be Cured?
  2802. Frequency of Testing
  2803. Test Results
  2804. Advantages
  2805. Table 19-2 Recommended Blood Glucose Levels for Patients With Diabetes
  2806. Hemoglobin A1c Test
  2807. Table 19-3 Comparison of Hemoglobin A1c Percentages With Average Blood Glucose Levels
  2808. Interpretation of Results
  2809. Glucose Meters
  2810. Reagent Test Strips
  2811. Calibration Procedure
  2812. 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.
  2813. Control Procedure
  2814. Figure 19-9 Glucose controls.
  2815. Care and Maintenance
  2816. Patient Teaching: Obtaining a Capillary Blood Specimen
  2817.  Procedure 19-1  Blood Glucose Measurement Using the Accu-Chek Advantage Glucose Meter
  2818. Outcome
  2819. Equipment/Supplies:
  2820. Assemble the equipment.
  2821. Insert the code key.
  2822. Check the code number.
  2823. Apply the control solution.
  2824. Control results should fall within the expected range.
  2825. Apply a drop of blood.
  2826. Read the glucose results.
  2827. Cholesterol
  2828. Highlight on Heart Disease With a Focus on Coronary Artery Disease
  2829. Coronary Artery Disease
  2830. Cause
  2831. CAD Risk Factors
  2832. HDL and LDL Cholesterol
  2833. Cholesterol Testing
  2834. Interpretation of Results
  2835. Patient Preparation
  2836. Figure 19-10 Cholestech LDX Cholesterol System.
  2837. CLIA-Waived Cholesterol Analyzers
  2838. What Would You Do? What Would You Not Do?
  2839. Case Study 3
  2840. Highlight on Lowering Cholesterol
  2841. Diet
  2842. Dietary Cholesterol
  2843. Saturated Fat
  2844. Soluble Fiber
  2845. Weight Reduction
  2846. Exercise
  2847. Smoking Cessation
  2848. Summary
  2849. Triglycerides
  2850. Blood Urea Nitrogen
  2851. Immunology
  2852. Immunologic Tests
  2853. Hepatitis Tests
  2854. HIV Tests
  2855. Syphilis Tests
  2856. Mononucleosis Test
  2857. Rheumatoid Factor
  2858. Antistreptolysin O Test
  2859. C-Reactive Protein
  2860. Cold Agglutinins
  2861. ABO and Rh Blood Typing
  2862. Rh Antibody Titer
  2863. Rapid Mononucleosis Testing
  2864. Figure 19-11 QuickVue+ mononucleosis test setup.
  2865. Figure 19-12 Procedure for performing the QuickVue+ Mononucleosis Test.
  2866. Figure 19-13 QuickVue+ mononucleosis test results.
  2867. Blood Typing
  2868. Blood Antigens
  2869. Blood Antibodies
  2870. Figure 19-14 Blood type depends on which antigens are present on the surface of the red blood cells (RBCs).
  2871. Table 19-4 ABO Blood Group System
  2872. Rh Blood Group System
  2873. Blood Antigen and Antibody Reactions
  2874. Highlight on Blood Donor Criteria
  2875. Health History
  2876. Age
  2877. Date of Last Donation
  2878. Weight
  2879. Temperature
  2880. Pulse
  2881. Blood Pressure
  2882. Hemoglobin
  2883. Blood-Donating Process
  2884. Processing the Blood
  2885. Agglutination and Blood Typing
  2886. Figure 19-15 The antigen-antibody reaction that occurs in vitro when the unknown blood sample is type A.
  2887. Medical Practice and the Law
  2888. Who Can Sue?
  2889. What Would You Do? What Would You Not Do?: Responses
  2890. Case Study 1
  2891. What Did Michelle Do?
  2892. What Did Michelle Not Do?
  2893. Case Study 2
  2894. What Did Michelle Do?
  2895. What Did Michelle Not Do?
  2896. Case Study 3
  2897. What Did Michelle Do?
  2898. What Did Michelle Not Do?
  2899.  Certification Review
  2900.  Terminology Review
  2901.  On The Web
  2902. Chapter 20 Medical Microbiology
  2903. Key Terms
  2904. Introduction to Microbiology
  2905. Normal Flora
  2906. Figure 20-1 Bacteria drawn by van Leeuwenhoek in 1684.
  2907. Infection
  2908. Stages of an Infectious Disease
  2909. Microorganisms and Disease
  2910. Bacteria
  2911. Figure 20-2 Classification of bacteria based on shape.
  2912. Cocci
  2913. What Would You Do? What Would You Not Do?
  2914. Case Study 1
  2915. Bacilli
  2916. Spirilla
  2917. Viruses
  2918. Figure 20-3 Types of bacteria. A, Staphylococci. B, Streptococci. C, Bacilli. D, Escherichia coli. E, Spirilla.
  2919. Microscope
  2920. Figure 20-4 Parts of the microscope.
  2921. Support System
  2922. Frame
  2923. Stage
  2924. Light Source
  2925. Condenser
  2926. Diaphragm
  2927. Adjustment Knobs
  2928. Optical System
  2929. Eyepiece
  2930. Objective Lenses
  2931. Focus
  2932. Low and High Power
  2933. Oil Immersion
  2934. Care of the Microscope
  2935. Procedure 20-1  Using the Microscope
  2936. Outcome
  2937. Equipment/Supplies:
  2938. Clean the lens.
  2939. Place the slide on the stage.
  2940. Focus the specimen.
  2941. Adjust the light.
  2942. Using the Oil-Immersion Objective
  2943. Place a drop of oil on the slide.
  2944. Move the lens until it just touches the oil.
  2945. Clean the oil from the lens.
  2946. Microbiologic Specimen Collection
  2947. Putting It All into Practice
  2948. Handling and Transporting Microbiologic Specimens
  2949. Wound Specimens
  2950. Collection and Transport Systems
  2951. Figure 20-5 Starswab II Collection and Transport System.
  2952. What Would You Do? What Would You Not Do?
  2953. Case Study 2
  2954. Memories of Practicum
  2955.  Procedure 20-2  Collecting a Throat Specimen
  2956. Outcome
  2957. Equipment/Supplies:
  2958. Remove the swab.
  2959. Collect the specimen.
  2960. Microbial Cultures
  2961. Figure 20-6 Streptococcal colonies growing on a blood agar culture medium contained in a Petri plate.
  2962. Streptococcus Testing
  2963. Rapid Streptococcus Tests
  2964. Hemolytic Reaction and Bacitracin Susceptibility Test
  2965. Figure 20-7 Procedure for performing the QuickVue In-Line One-Step Strep A test.
  2966. 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.
  2967. Sensitivity Testing
  2968. Microscopic Examination of Microorganisms
  2969. Figure 20-9 Sensitivity testing.
  2970. Wet Mount Method
  2971. Figure 20-10 Wet mount method of slide preparation for examining microorganisms in the living state.
  2972. Patient Teaching: Strep Throat
  2973. What is Strep Throat?
  2974. What are the Symptoms of Strep Throat?
  2975. How is Strep Throat Diagnosed and Treated?
  2976. What are the Complications of Strep Throat?
  2977. What Would You Do? What Would You Not Do?
  2978. Case Study 3
  2979. 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.
  2980. Smears
  2981. Gram Stain
  2982. Prevention and Control of Infectious Diseases
  2983. Procedure 20-3  Preparing a Smear
  2984. Outcome
  2985. Equipment/Supplies:
  2986. Spread the specimen over the slide.
  2987. Heat-fix the smear.
  2988. Medical Practice and the Law
  2989. What Would You Do? What Would You Not Do?: Responses
  2990. Case Study 1
  2991. What Did Natalie Do?
  2992. What Did Natalie Not Do?
  2993. Case Study 2
  2994. What Did Natalie Do?
  2995. What Did Natalie Not Do?
  2996. Case Study 3
  2997. What Did Natalie Do?
  2998. What Did Natalie Not Do?
  2999.  Certification Review
  3000.  Terminology Review
  3001.  On The Web
  3002. Chapter 21 Emergency Medical Procedures
  3003. Key Terms
  3004. Introduction to Emergency Medical Procedures
  3005. Office Crash Cart
  3006. Emergency Medical Services System
  3007. Table 21-1 Office Crash Cart
  3008. First-Aid Kit
  3009. Figure 21-1 First aid kit.
  3010. OSHA Safety Precautions
  3011. Guidelines for Providing Emergency Care
  3012. Highlight on Good Samaritan Laws
  3013. Respiratory Distress
  3014. Asthma
  3015. Emphysema
  3016. Hyperventilation
  3017. Heart Attack
  3018. Stroke
  3019. Shock
  3020. Hypovolemic Shock
  3021. Cardiogenic Shock
  3022. Neurogenic Shock
  3023. Anaphylactic Shock
  3024. Figure 21-2 Anaphylactic emergency epinephrine injector.
  3025. Psychogenic Shock
  3026. Figure 21-3 Prevention and treatment of fainting.
  3027. Figure 21-4 Prevention of fainting.
  3028. Bleeding
  3029. External Bleeding
  3030. Capillary Bleeding
  3031. Venous Bleeding
  3032. Arterial Bleeding
  3033. Emergency Care for External Bleeding
  3034. Figure 21-5 Locations of pressure points. Shaded areas show the regions in which bleeding may be controlled by pressure at the points indicated.
  3035. Nosebleeds
  3036. Emergency Care for a Nosebleed
  3037. Putting It All into Practice
  3038. 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.
  3039. 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.
  3040. Internal Bleeding
  3041. Wounds
  3042. Open Wounds
  3043. Incisions and Lacerations
  3044. Emergency Care for Incisions and Lacerations
  3045. Minor Incisions and Lacerations
  3046. Figure 21-8 Types of wounds.
  3047. Figure 21-9 Minor incisions and lacerations should be cleaned with soap and water to remove dirt and other debris.
  3048. Serious Incisions and Lacerations
  3049. Punctures
  3050. Emergency Care for Puncture Wounds
  3051. Abrasions
  3052. Emergency Care for Abrasions
  3053. Closed Wounds
  3054. Musculoskeletal Injuries
  3055. Fracture
  3056. Figure 21-10 Fractures. A, Open fracture. B, Closed fracture.
  3057. Dislocation
  3058. Sprain
  3059. Figure 21-11 Types of fractures.
  3060. Strain
  3061. Emergency Care for a Fracture
  3062. 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.
  3063. Burns
  3064. Superficial (First-Degree) Burn
  3065. Partial-Thickness (Second-Degree) Burn
  3066. Full-Thickness (Third-Degree) Burn
  3067. Figure 21-13 Types of burns.
  3068. Thermal Burns
  3069. Emergency Care for Major Thermal Burns
  3070. Emergency Care for Minor Thermal Burns
  3071. Chemical Burns
  3072. Seizures
  3073. Emergency Care for Seizures
  3074. Poisoning
  3075. Ingested Poisons
  3076. Memories of Practicum
  3077. What Would You Do? What Would You Not Do?
  3078. Case Study 1
  3079. Emergency Care for Poisoning by Ingestion
  3080. Inhaled Poisons
  3081. Emergency Care for Inhaled Poisons
  3082. Absorbed Poisons
  3083. Emergency Care for Absorbed Poisons
  3084. What Would You Do? What Would You Not Do?
  3085. Case Study 2
  3086. Injected Poisons
  3087. Insect Stings
  3088. Emergency Care for Insect Stings
  3089. Figure 21-14 Removing a honeybee stinger and venom sac using the edge of a credit card.
  3090. Spider Bites
  3091. Emergency Care for Spider Bites
  3092. Snakebites
  3093. Emergency Care for Snakebites
  3094. Animal Bites
  3095. Emergency Care for Animal Bites
  3096. Heat and Cold Exposure
  3097. Heat Cramps
  3098. Heat Exhaustion
  3099. Heatstroke
  3100. 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.
  3101. What Would You Do? What Would You Not Do?
  3102. Case Study 3
  3103. Frostbite
  3104. Hypothermia
  3105. Diabetic Emergencies
  3106. Emergency Care in Diabetes
  3107. Insulin Shock (Hypoglycemia)
  3108. Figure 21-16 Diabetic medical identification. A, Diabetic medical alert bracelet. B, Diabetic wallet card.
  3109. Figure 21-17 Orange juice is administered to a diabetic patient showing signs and symptoms of insulin shock.
  3110. Diabetic Coma (Diabetic Ketoacidosis)
  3111. Doubtful Situations
  3112. Medical Practice and the Law
  3113. What Would You Do? What Would You Not Do?: Responses
  3114. Case Study 1
  3115. What Did Judy Do?
  3116. What Did Judy Not Do?
  3117. Case Study 2
  3118. What Did Judy Do?
  3119. What Did Judy Not Do?
  3120. Case Study 3
  3121. What Did Judy Do?
  3122. What Did Judy Not Do?
  3123.  Certification Review
  3124.  Terminology Review
  3125.  On The Web
  3126. Appendix A Medical Abbreviations
  3127. Glossary
  3128. Index
  3129. A
  3130. B
  3131. C
  3132. D
  3133. E
  3134. F
  3135. G
  3136. H
  3137. I
  3138. J
  3139. K
  3140. L
  3141. M
  3142. N
  3143. O
  3144. P
  3145. Q
  3146. R
  3147. S
  3148. T
  3149. U
  3150. V
  3151. W
  3152. X
  3153. Y
  3154. Z


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