Copyright 2010, 2006, 2002, 1997 Delmar, Cengage Learning. Library of Congress Control Number: ISBN-13:

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3 Delmar s Clinical Medical Assisting, Fourth Edition Wilburta Q. Lindh, Marilyn S. Pooler, Carol D. Tamparo, Barbara M. Dahl Vice President, Career and Professional Editorial: Dave Garza Director of Learning Solutions: Matthew Kane Senior Acquisitions Editor: Rhonda Dearborn Managing Editor: Marah Bellegarde Senior Product Manager: Sarah Prime Editorial Assistant: Chiara Astriab Vice President, Career and Professional Marketing: Jennifer McAvey Marketing Director: Wendy Mapstone Senior Marketing Manager: Nancy Bradshaw Marketing Coordinator: Erica Ropitzky Production Director: Carolyn Miller Content Project Manager: Anne Sherman Senior Art Director: Jack Pendleton Senior Technology Product Manager: Mary Colleen Liburdi Technology Project Manager: Ben Knapp Technology Project Manager: Erin Zeggert Copyright 2010, 2006, 2002, 1997 Delmar, Cengage Learning ALL RIGHTS RESERVED. No part of this work covered by the copyright herein may be reproduced, transmitted, stored, or used in any form or by any means, graphic, electronic, or mechanical, including but not limited to photocopying, recording, scanning, digitizing, taping, Web distribution, information networks, or information storage and retrieval systems, except as permitted under Section 107 or 108 of the 1976 United States Copyright Act, without the prior written permission of the publisher. For product information and technology assistance, contact us at Cengage Learning Customer & Sales Support, For permission to use material from this text or product, submit all requests online at Further permissions questions can be ed to permissionrequest@cengage.com This publication includes images from CorelDRAW which are protected by the copyright laws of the U.S., Canada and elsewhere. Used under license. Library of Congress Control Number: ISBN-13: ISBN-10: Delmar 5 Maxwell Drive Clifton Park, NY USA Cengage Learning is a leading provider of customized learning solutions with office locations around the globe, including Singapore, the United Kingdom, Australia, Mexico, Brazil, and Japan. Locate your local office at: international.cengage.com/region Cengage Learning products are represented in Canada by Nelson Education, Ltd. To learn more about Delmar, visit Purchase any of our products at your local college store or at our preferred online store Notice to the Reader Publisher does not warrant or guarantee any of the products described herein or perform any independent analysis in connection with any of the product information contained herein. Publisher does not assume, and expressly disclaims, any obligation to obtain and include information other than that provided to it by the manufacturer. The reader is expressly warned to consider and adopt all safety precautions that might be indicated by the activities described herein and to avoid all potential hazards. By following the instructions contained herein, the reader willingly assumes all risks in connection with such instructions. The publisher makes no representations or warranties of any kind, including but not limited to, the warranties of fitness for particular purpose or merchantability, nor are any such representations implied with respect to the material set forth herein, and the publisher takes no responsibility with respect to such material. The publisher shall not be liable for any special, consequential, or exemplary damages resulting, in whole or part, from the readers use of, or reliance upon, this material. Printed in the United States of America

4 Table of Contents List of Procedures xi Preface xiii Supplements at-a-glance xvii About the Authors xviii Acknowledgments xx Contributors xxii Reviewers xxiii How to Use the Book xxiv How to Use the StudyWARE Software CD xxvi How to Use the Critical Thinking Challenge 2.0 xxvii SECTION I: GENERAL PROCEDURES 1 Unit 1: Introduction to Medical Assisting and Health Professions 2 Chapter 1: The Medical Assisting Profession 3 Historical Perspective of the Profession... 5 Career Opportunities Education of the Medical Assistant Courses in a Medical Assisting Program Practicum Associate and Bachelor Degrees Accreditation of Medical Assisting Programs CAAHEP ABHES Attributes of a Medical Assistant Professional Empathy Attitude Dependability Initiative Flexibility Desire to Learn Physical Attributes Ability to Communicate Ethical Behavior American Association of Medical Assistants..11 Certification Continuing Education American Medical Technologists Registered Medical Assistant Certified Medical Administrative Specialist.. 13 Continuing Education National Healthcareer Association Certification Continuing Education Regulation of Health Care Providers Scope of Practice Chapter 2: Health Care Settings and the Health Care Team 19 Ambulatory Health Care Settings Individual and Group Medical Practices Urgent Care Centers Managed Care Operations Boutique or Concierge Medical Practice The Health Care Team The Title Doctor Health Care Professionals and Their Roles Integrative Medicine and Alternative Health Care Practitioners Future of Integrative Medicine Allied Health Professionals and Their Roles The Role of the Medical Assistant Health Unit Coordinator Medical Laboratory Technologist Registered Dietitian Pharmacist Pharmacy Technician Phlebotomist Physical Therapist Physical Therapy Assistant Nurse Physician Assistant The Value of the Medical Assistant to the Health Care Team Chapter 3: History of Medicine 36 Cultural Heritage in Medicine Medical Specialists in History History of Medical Education History of Attitudes toward Illness Historical Medical Treatments The Scourge of Epidemics Significant Contributions to Medicine Women in Medicine Frontiers in Medicine Unit 2: The Therapeutic Approach 50 Chapter 4: Therapeutic Communication Skills 51 Importance of Communication The Communication Cycle The Sender The Message The Receiver Feedback Listening Skills Types of Communication Verbal Communication Nonverbal Communication Congruency in Communication Factors Affecting Therapeutic Communication Age and Gender Barriers Economic Barriers Education and Life Experience Barriers.. 59 Bias and Prejudice Barriers Verbal Roadblocks to Therapeutic Communication Defense Mechanisms as Barriers Barriers Caused by Cultural and Religious Diversity Human Needs as Barriers to Therapeutic Communication Maslow s Hierarchy of Needs Establishing Multicultural Communication Cultural Brokering Therapeutic Communication in Action Interview Techniques Point of Care Techniques Community Resources Chapter 5: Coping Skills for the Medical Assistant 71 What Is Stress? Adaptation to Stress Management of Stress What Is Burnout? Stages of Burnout Role of Personality and Work Environment Burnout Prevention What to Do If You Are Burned Out Goal Setting as a Stress Reliever Table of Contents iii

5 Chapter 6: The Therapeutic Approach to the Patient with a Life-Threatening Illness 81 Life-Threatening Illness Cultural Perspective on Life-Threatening Illness Choices in Life-Threatening Illness The Range of Psychological Suffering The Therapeutic Response to the Patient with HIV/AIDS The Therapeutic Response to the Patient with Cancer The Therapeutic Response to the Patient with End-Stage Renal Disease The Stages of Grief Denial Anger Bargaining Depression Acceptance The Challenge for the Medical Assistant Unit 3: Responsible Medical Practice 92 Chapter 7: Legal Considerations 93 Sources of Law Statutory Law Common Law Criminal Law Civil Law Administrative Law Title VII of the Civil Rights Act Federal Age Discrimination Act Uniform Anatomical Gift Act Regulation Z of the Consumer Protection Act Occupational Safety and Health Act Controlled Substances Act Americans with Disabilities Act Family and Medical Leave Act Health Insurance Portability and Accountability Act Contract Law Termination of Contracts Tort Law Medical Practice Acts Standard of Care Informed Consent Implied Consent Consent and Legal Incompetence Risk Management Civil Litigation Process Subpoenas Discovery Pretrial Conference Trial Statute of Limitations Public Duties Reportable Diseases/Injuries Abuse Good Samaritan Laws Advance Directives Living Wills/Advance Directives Durable Power of Attorney for Health Care Patient Self-Determination Act Chapter 8: Ethical Considerations 120 Ethics Principle-Centered Leadership Five Ps of Ethical Power Ethics Check Questions Bioethics Keys to the AAMA Code of Ethics Ethical Guidelines for Health Care Providers Advertising Confidentiality Medical Records Professional Fees and Charges Professional Rights and Responsibilities Disaster Response Treatment for a Culturally Diverse Clientele Care of the Poor Abuse Bioethical Dilemmas Allocation of Scarce Medical Resources Abortion and Fetal Tissue Research Genetic Engineering/Manipulation Artificial Insemination/Surrogacy In Vitro Fertilization Dying and Death HIV and AIDS Chapter 9: Emergency Procedures and First Aid 137 Recognizing an Emergency Responding to an Emergency Primary Survey Using the 911 or Emergency Medical Services System Good Samaritan Laws Blood, Body Fluids, and Disease Transmission Preparing for an Emergency The Medical Crash Tray or Cart Common Emergencies Shock Wounds Burns Musculoskeletal Injuries Heat- and Cold-Related Illnesses Poisoning Sudden Illness Cerebral Vascular Accident Heart Attack Breathing Emergencies and Cardiac Arrest Rescue Breathing Cardiopulmonary Resuscitation Safety and Emergency Practices SECTION II: CLINICAL PROCEDURES 167 Unit 4: Integrated Clinical Procedures 168 Chapter 10: Infection Control and Medical Asepsis 169 Impact of Infectious Diseases The Process of Infection Growth Requirements for Microorganisms Chain of Infection Infectious Agents Reservoir Portal of Exit Means of Transmission Portal of Entry Susceptible Host The Body s Defense Mechanisms for Fighting Infection and Disease The Body s Natural Barriers Inflammatory Response The Immune System and Immunity Stages of Infectious Diseases Incubation Stage Prodromal Stage Acute Stage Declining Stage Convalescent Stage Disease Transmission Human Immunodeficiency Virus and Hepatitis B and C HIV and AIDS Acute Viral Hepatitis Diseases Reporting Infectious Disease Standard Precautions Transmission-Based Precautions Blood and Body Fluids Personal Protective Equipment Needlestick Disposal of Infectious Waste Federal Organizations and Infection Control OSHA Regulations The Bloodborne Pathogen Standard OSHA Regulations and Students Avoiding Exposure to Bloodborne Pathogens Principles of Infection Control Medical Asepsis iv Table of Contents

6 Hand Washing Sanitization Disinfection Bioterrorism Chapter 11: The Patient History and Documentation 231 The Purpose of the Medical History Preparing for the Patient A Cross-Cultural Model Patient Information Forms Demographic Data Form Financial Information Form Privacy Information Form Release of Information Form Medical History Form Computerized Health History The Patient Intake Interview Interacting with the Patient Displaying Cultural Awareness Being Sensitive to Patient Needs Approaching Sensitive Topics Communication across the Life Span The Medical Health History SOAP/SOAPER and CHEDDAR Chief Complaint Present Illness Medical History Family History Social History Review of Systems (ROS) The Patient Record and Its Importance HIPAA Compliance Contents of Medical Records Continuity of Care Record Methods of Charting/Documentation Source-Oriented Medical Records Problem-Oriented Medical Records Electronic Medical Records (EMR) Rules of Charting Abbreviations Used in Charting Chart Organization Chapter 12: Vital Signs and Measurements 257 The Importance of Accuracy Temperature Terms Used to Describe Body Temperature Phase Out of Mercury Thermometers and Other Mercury-Containing Equipment Types of Thermometers Measuring Temperature Recording Temperature Cleaning and Storage of Thermometers. 265 Pulse Pulse Sites Measuring and Evaluating a Pulse Normal Pulse Rates Pulse Abnormalities Recording Pulse Rates Respiration Respiration Rate Abnormalities Blood Pressure Equipment for Measuring Blood Pressure Measuring Blood Pressure Recording Blood Pressure Measurement Normal Blood Pressure Readings Blood Pressure Abnormalities Height and Weight Height Weight Significance of Weight Measuring Chest Circumference Chapter 13: The Physical Examination 293 Methods of Examination Observation or Inspection Palpation Percussion Auscultation Mensuration Manipulation Positioning and Draping Examination Positions Equipment and Supplies for the Physical Examination Basic Components of a Physical Examination Patient Appearance Gait Stature Posture Body Movements Speech Breath Odors Nutrition Skin and Appendages The Physical Examination Sequence Head Eyes Ears Nose Mouth and Throat Neck Chest Breast Abdomen Genitals Rectum Reflexes After the Examination Unit 5: Assisting with Specialty Examinations and Procedures 314 Chapter 14: Obstetrics and Gynecology 315 Obstetrics Initial Prenatal Visit Subsequent or Return Prenatal Visits Disorders of Pregnancy Parturition Postpartum Period Gynecology The Gynecologic Examination Gynecologic Diseases and Conditions Other Diagnostic Tests and Treatments for Reproductive System Diseases Complementary Therapy in Obstetrics and Gynecology Chapter 15: Pediatrics 365 What Is Pediatrics? Preparation of Vaccines for Administration Recommended Vaccination Schedule Considerations for Vaccine Administration Giving Injections to Pediatric Patients Theories of Growth and Development Newborns Infants Toddlers Preschoolers School-Aged Children Adolescents Growth Patterns Measuring the Infant or Child Length and Weight Measurements Infant Holds and Positions Height and Weight Measuring Devices Measuring Head Circumference Measuring Chest Circumference Infant/Child Failure to Thrive Pediatric Vital Signs Temperature Pulse Respirations Blood Pressure Collecting a Urine Specimen from an Infant Screening Infants for Hearing Impairment Screening Infant and Child Visual Acuity Common Disorders and Diseases Otitis Media The Common Cold Tonsillitis Pediculosis Table of Contents v

7 Asthma Croup Pertussis (Whooping Cough) Respiratory Syncytial Virus Attention Deficit Hyperactivity Disorder Child Abuse Male Circumcision Chapter 16: Male Reproductive System 410 Testicular Self-Examination Disorders of the Male Reproductive System Testicular Cancer Epididymitis Prostatitis Prostate Cancer Benign Prostatic Hypertrophy Sexually Transmitted Diseases Balanitis Infertility Erectile Dysfunction Assisting with the Male Reproductive Examination Diagnostic Tests and Procedures Vasectomy Semen Analysis Urodynamic Studies Chapter 17: Gerontology 423 Societal Bias Facts about Aging Physiologic Changes Senses Integumentary System Nervous System Musculoskeletal System Respiratory System Cardiovascular System Gastrointestinal System Urinary System Reproductive System Prevention of Complications Psychological Changes The Medical Assistant and the Geriatric Patient Memory-Impaired Older Adults Visually Impaired Older Adults Hearing-Impaired Older Adults Elder Abuse Healthy and Successful Aging Chapter 18: Examinations and Procedures of Body Systems 437 Urinary System Signs and Symptoms of Urinary Conditions and Disorders Diagnostic Tests Urinary Catheterization Digestive System Signs and Symptoms of Digestive Conditions and Disorders Diagnostic Tests Bariatrics Sensory System The Eye The Ear The Nose Respiratory System Signs and Symptoms of Respiratory Conditions and Disorders Diagnostic Tests Spirometry Peak Expiratory Flow Rates Pulse Oximetry Inhalers Musculoskeletal System Fractures, Casting, and Cast Removal Neurologic System Components of a Neurologic Screening Circulatory System Blood and Lymph System Integumentary System Allergy Skin Testing Unit 6: Advanced Techniques and Procedures 522 Chapter 19: Assisting with Offi ce/ambulatory Surgery 523 Surgical Asepsis and Sterilization Hand Cleansing (Hand Hygiene) for Medical and Surgical Asepsis Sterile Principles Methods of Sterilization Gas Sterilization Dry Heat Sterilization Chemical ( Cold ) Sterilization Steam Sterilization (Autoclave) Common Surgical Procedures Performed in Providers Offices and Clinics Additional Surgical Methods Electrosurgery Cryosurgery Laser Surgery Suture Materials and Supplies Suture/Ligature Suture Needles Staples Staple Removal Instruments Structural Features Categories and Uses Care of Instruments Supplies and Equipment Drapes Sponges and Wicks Solutions/Creams/Ointments Dressings and Bandages Anesthetics Patient Care and Preparation Patient Preparation and Education Informed Consent Medical Assisting Considerations Postoperative Instructions Wounds, Wound Care, and the Healing Process Basic Surgery Setup Basic Rules and Concepts for Setup of Surgical Trays Surgery Process Preparation for Surgery Using Dry Sterile Transfer Forceps Chapter 20: Diagnostic Imaging 589 Radiation Safety X-Ray Machine Contrast Media Patient Preparation Positioning the Patient Fluoroscopy Bone Densitometry Diagnostic Imaging Positron Emission Tomography (PET) Computerized Tomography (CT) Magnetic Resonance Imaging (MRI) X-Rays (Flat Plates) Ultrasonography Mammography Filing Films and Reports Radiation Therapy Nuclear Medicine Chapter 21: Rehabilitation and Therapeutic Modalities 605 The Role of the Medical Assistant in Rehabilitation Principles of Body Mechanics Posture Using the Body Safely and Effectively Lifting Techniques Transferring Patients Assisting Patients to Ambulate Assistive Devices Walkers Crutches Canes Wheelchairs Therapeutic Exercises Range of Motion Muscle Testing Types of Therapeutic Exercise Electromyography Electrostimulation of Muscle Therapeutic Modalities Heat and Cold Moist and Dry Heat vi Table of Contents

8 Moist and Dry Cold Ultrasound Massage Therapy Chapter 22: Nutrition in Health and Disease 638 Nutrition and Digestion Types of Nutrients Energy Nutrients (Organic) Other Nutrients (Inorganic) Reading Food Labels Items on the Nutrition Label Comparing Labels Nutrition at Various Stages of Life Pregnancy and Lactation Breast-Feeding Infancy Childhood Adolescence Older Adults Therapeutic Diets Weight Control Diabetes Mellitus Cardiovascular Disease Cancer Diet and Culture Chapter 23: Basic Pharmacology 672 Medical Uses of Drugs Drug Names History and Sources of Drugs Plant Sources Animal Sources Mineral Sources Herbal Supplements Synthetic Drugs Genetically Engineered Pharmaceuticals Drug Regulations and Legal Classifications of Drugs Controlled Substance Act of Prescription Drugs Nonprescription Drugs Proper Disposal of Drugs Administer, Prescribe, Dispense Drug References and Standards How to Use the PDR Other Reference Sources Classification of Drugs Principal Actions of Drugs Factors That Affect Drug Action Undesirable Actions of Drugs Drug Routes Forms of Drugs Liquid Preparations Solid and Semisolid Preparations Other Drug Delivery Systems Storage and Handling of Medications Emergency Drugs and Supplies Bioterrorism Drug Abuse Chapter 24: Calculation of Medication Dosage and Medication Administration 704 Legal and Ethical Implications of Medication Administration Ethical Considerations The Medication Order The Prescription Drug Dosage Age Weight Sex Other Factors The Medication Label Calculation of Drug Dosages Understanding Ratio Understanding Proportion Weights and Measures Medications Measured in Units How to Calculate Unit Dosages Insulin Diabetes Calculating Adult Dosages The Proportional Method The Formula Method Calculating Children s Dosages Body Surface Area Kilogram of Body Weight Administration of Medications The Six Rights of Proper Drug Administration Medication Errors Patient Assessment Administration of Oral Medications Equipment and Supplies for Oral Medications Administration of Parenteral Medications Hazards Associated with Parenteral Medications Reasons for Parenteral Route Selection Parenteral Equipment and Supplies Principles of Intravenous Therapy Site Selection and Injection Angle Marking the Correct Site for Intramuscular Injection Basic Guidelines for Administration of Injections Z-Track Method of Intramuscular Injection Administration of Allergenic Extracts Administration of Inhaled Medications Implications for Patient Care Administration of Oxygen Chapter 25: Electrocardiography 760 Anatomy of the Heart Electrical Conduction System of the Heart The Cardiac Cycle and the ECG Cycle Calculation of Heart Rate on ECG Graph Paper Types of Electrocardiographs Single-Channel Electrocardiograph Multichannel Electrocardiograph Automatic Electrocardiograph Machines Electrocardiograph Telephone Transmissions Facsimile Electrocardiograph Interpretive Electrocardiograph ECG Equipment Electrocardiograph Paper Electrolyte Sensors or Electrodes Lead Wires Electrocardiograph Machine Care of Equipment Lead Coding The Electrocardiograph and Sensor Placement Standard Limb or Bipolar Leads Augmented Leads Chest Leads or Precordial Leads Standardization and Adjustment of the Electrocardiograph Standard Resting Electrocardiography Mounting the ECG Tracing Interference or Artifacts Somatic Tremor Artifacts AC Interference Wandering Baseline Artifacts Interrupted Baseline Artifacts Patients with Unique Problems Myocardial Infarctions (Heart Attacks) Cardiac Arrhythmias Atrial Arrhythmias Ventricular Arrhythmias Defibrillation Other Cardiac Diagnostic Tests Holter Monitor (Portable Ambulatory Electrocardiograph) Loop ECG Treadmill Stress Test or Exercise Tolerance ECG Thallium Stress Test Echocardiography/Ultrasonography Cardiac Procedures Procedures for Heart Disease Procedures for Arrhythmias Table of Contents vii