Kinn's The Medical Assistant - E-Book

Deborah B. Proctor; Alexandra Patricia Adams

BOOK

Kinn's The Medical Assistant - E-Book

Deborah B. Proctor | Alexandra Patricia Adams

(2013)

Additional Information

Book Details

ISBN: 978-0-323-18781-7
Edition: 12
Language: English
Pages: 1392
Subjects: Medical profession
Dentistry
Nursing & ancillary services

Abstract

Prepare for a successful career in medical assisting! Kinn’s The Medical Assistant, 12th Edition helps you learn the real-world administrative and clinical skills essential to working in the health care setting. Administrative coverage ranges from professionalism and interpersonal skills to billing and coding and electronic health records; clinical content teaches how to assist with medications, diagnostic procedures, and surgeries. And no other comprehensive medical assisting text can match its coverage of assisting with medical specialties! Written by medical assisting experts Alexandra Adams and Deborah Proctor, this classic resource also includes an Evolve companion website with practical exercises and activities, videos, and review questions for the CMA and RMA certification exams.

More chapters on assisting with medical specialties than any other Medical Assisting text prepare you to assist in specialty exams and make you better qualified to work in specialty fields like cardiology, dermatology, ophthalmology, gynecology, and neurology.
Step-by-step, illustrated procedures make it easier to learn and understand medical assisting skills, and include rationales for each step.
Threaded case scenarios help you develop critical thinking skills and apply concepts to realistic administrative and clinical situations.
Patient education and legal and ethical issues are described in relation to the Medical Assistant's job.
A Portfolio Builder on the Evolve website helps you demonstrate proficiency to potential employers.
Detailed learning objectives and vocabulary with definitions in each chapter help you study more effectively, with connections icons linking concepts in the text to exercises in the study guide and on the Evolve companion website.
Study Guide includes a variety of exercises to test your knowledge and critical thinking skills, case scenarios from the book, and a Procedure Checklists Manual. Sold separately.

NEW! Charting examples within the procedures are highlighted for easier learning.
UPDATED coverage of the Electronic Health Record ensures that you are familiar with the technology you'll use on the job.
UPDATED content on alternative therapies and treatment includes the latest herbal remedies such as red rice yeast for lowering cholesterol, St. John’s Wort for depression, and probiotic bacteria for GI maladies.

Section Title	Page	Action	Price
Front cover	cover
Inside front cover	ifc1
Half title page	i
Evolve page	ii
Kinn's The Medical Assistant, 12/e	iii
Copyright page	iv
Dediction	v
Preface	vii
Distinctive Features of Our Approach	vii
Key Features in this Edition	vii
Evolve	vii
Study Guide and Procedure Checklists	viii
Kinn’s Medical Assisting Online	viii
Special Features	ix
Reviewers	xi
Acknowledgments	xiii
Table of Contents	xv
Procedures	xvii
Introduction	1
1 Becoming a Successful Student	1
Learning Objectives	1
Vocabulary	2
Scenario	1
Who You are as a Learner: How Do You Learn Best?	2
Learning Style Inventory	2
Using Your Learning Profile to Be a Successful Student: Where Do I Go from Here?	3
Time Management: Putting Time on Your Side	4
How to Put Time on Your Side	4
Problem Solving and Conflict Management	5
Assertive Communication	6
Nonassertive and Aggressive Behaviors and Language	6
Study Skills: Tricks for Becoming a Successful Student	7
Test-Taking Strategies: Taking Charge of Your Success	8
Becoming a Critical Thinker: Making Mental Connections	9
Connections	10
Study Guide Connection:	10
Evolve Connection:	10
2 The Healthcare Industry	11
Learning Objectives	11
Vocabulary	12
Scenario	11
The History of Medicine	13
Medical Language and Mythology	13
Medicine in Ancient Times	13
Early Development of Medical Education	14
Early Medical Pioneers	14
Medical Advances in the Eighteenth and Nineteenth Centuries	15
Nineteenth Century Women in Medicine	17
Modern Milestones in Medicine	18
The National View of Healthcare	20
World Health Organization	20
U.S. Department of Health and Human Services	20
U.S. Army Medical Research Institute of Infectious Diseases	20
Centers for Disease Control and Prevention	21
National Institutes of Health	21
Types of Healthcare Facilities	21
Hospitals	21
Ambulatory Care	23
Other Healthcare Facilities	23
Types of Medical Practice	24
Sole Proprietorship	24
Partnership	24
Corporation	24
Healthcare Professionals	24
Title of “Doctor”	25
Doctors of Medicine	25
Doctors of Osteopathy	25
Doctors of Chiropractic	25
Hospitalists	25
Dentists	27
Optometrists	27
Podiatrists	28
Other Doctorates	28
Nurses	28
Registered Nurses	28
Licensed Practical and Vocational Nurses	28
Nurse Practitioners	28
Nurse Anesthetists	28
Other Healthcare Professionals	28
Closing Comments	28
Patient Education	28
Legal and Ethical Issues	28
Summary of Scenario	32
Connections	34
Study Guide Connection:	34
Evolve Connection:	34
Unit One Introduction to Medical Assisting	35
3 The Medical Assisting Profession	35
Learning Objectives	35
Vocabulary	36
Scenario	35
The History of Medical Assisting	36
The Scope of Practice of a Medical Assistant	37
A Career in Medical Assisting	38
Professional Appearance	39
Education and Training	40
Classroom Training	40
Externship (Practicum)	40
Continuing Education	41
Professional Organizations	42
American Association of Medical Assistants and Certified Medical Assistants	42
American Medical Technologists and Registered Medical Assistants	42
National Healthcareer Association	43
American Registry of Medical Assisting	43
National Center for Competency Testing	43
Taking Certification Examinations	43
The Difference Between CMAs and RMAs	44
Closing Comments	44
Patient Education	44
Legal and Ethical Issues	44
Connections	47
Study Guide Connection:	47
Evolve Connection:	47
4 Professional Behavior in the Workplace	48
Learning Objectives	48
Vocabulary	49
Scenario	48
The Meaning of Professionalism	49
Work Ethics	49
Characteristics of Professionalism	50
Loyalty	50
Dependability	50
Courtesy	50
Initiative	50
Flexibility	51
Credibility	51
Confidentiality	51
Attitude	51
Obstructions to Professionalism	51
Personal Problems and “Baggage”	51
Rumors and the “Grapevine”	52
Personal Phone Calls and Business	52
Office Politics	52
Professional Attributes	53
Teamwork	53
Time Management	53
Prioritizing	53
Setting Goals	53
Knowing the Facility and Its Employees	53
Documentation	54
Note Taking	54
Interpersonal Skills	54
Substance Abuse	54
Closing Comments	55
Patient Education	55
Legal and Ethical Issues	55
Summary of Scenario	56
Connections	57
Study Guide Connection:	57
Evolve Connection:	57
5 Interpersonal Skills and Human Behavior	58
Learning Objectives	58
Vocabulary	59
Scenario	58
First Impressions	59
Patient-Centered Care	60
Communication Paths	60
Verbal Communication	60
Nonverbal Communication	61
The Process of Communication	63
Listening	63
Warnings Against Advising a Patient	65
Observing Carefully	65
Psychological Disorders	66
Defense Mechanisms	66
Verbal Aggression	66
Handling Verbal Aggression	66
Sarcasm	67
Handling Sarcasm	67
Rationalization	67
Handling Rationalization	67
Compensation	67
Handling Compensation	67
Regression	67
Handling Regression	67
Repression	67
Handling Repression	67
Apathy	67
Handling Apathy	67
Displacement	67
Handling Displacement	68
Denial	68
Handling Denial	68
Physical Avoidance	68
Handling Physical Avoidance	68
Projection	68
Handling Projection	68
Conflict	68
Resolving Conflict	69
Boundaries	69
Self-Boundaries	69
The Crazy-Makers: Passive-Aggressive Communication	70
The Avoider	70
The Pseudoaccommodator	70
The Guilt-Maker	70
The Subject Changer	70
The Distracter	70
The Mind Reader	70
The Trapper	70
The Crisis Tickler	70
The Gunnysacker	70
The Trivial Tyrannizer	70
The Beltliner	70
The Joker	70
The Blamer	70
The Contract Tyrannizer	70
The Kitchen Sink Fighter	70
The Withholder	71
The Benedict Arnold	71
Barriers to Communication	71
Physical Impairment	71
Language	71
Prejudice	71
Stereotyping	71
Perception	71
Overcoming Barriers to Communication	72
Communication during Difficult Times	72
Anger	72
Shock	72
Death and Dying	73
Multicultural Issues	74
Communicating with People of Other Cultures	74
Communicating during the Patient Encounter	74
Maslow’s Hierarchy of Needs	75
Approval, Acceptance, and Achievement	75
A Good Night’s Sleep	75
Healthy Nutrition	75
Positive Relationships	75
Healthy Self-Esteem	76
Improving Yourself	76
Comfort Zones	76
Closing Comments	76
Patient Education	77
Legal and Ethical Issues	77
Summary of Scenario	77
Connections	79
Study Guide Connection:	79
Evolve Connection:	79
6 Medicine and Ethics	80
Learning Objectives	80
Vocabulary	81
Scenario	80
History of Ethics in Medicine	83
Who Decides What is Ethical?	83
The Role of the American Medical Association and Its Council on Ethical and Judicial Affairs in Issues of Ethics	84
Making Ethical Decisions	84
Elements of Ethics	84
Types of Ethical Problems	85
The Ethical Decision-Making Process	85
Current Opinions of the Council on Ethical and Judicial Affairs and Medicine’s Ethical Issues	86
Abortion	86
Abuse	86
Allocation of Health Resources	86
Artificial Insemination/In Vitro Fertilization	86
Stem Cell Research	87
Surrogate Motherhood	87
Genetic Counseling	87
Family and Intimate Partner Violence	87
Ethical Responsibility to Study and Prevent Error and Harm	87
Physician-Assisted Suicide	87
Surrogate Decision Making	87
Withholding or Withdrawing Life-Prolonging Treatment	88
Quality of Life	88
Fees for Medical Services	88
Organ Donation	88
Capital Punishment	88
Potential Patients	88
Withholding Information from Patients	89
Healthcare Fraud and Abuse	89
National Health Information Technology	89
Genetic Information and the Criminal Justice System	89
Gifts to Physicians from Industry	89
Informed Consent	89
Interprofessional Relationships	89
Confidentiality and Patient Privacy	90
Advertising	90
Communication with the Media	90
Physician Obligations in Emergency Preparedness and Response	91
Malevolent Use of Biomedical Research	91
Racial and Ethnic Healthcare Disparities	91
Diagnostic Imaging on Request	91
Computers	91
Fees and Charges	91
Fee Splitting and Contingent Fees	91
Insurance Forms	92
Waiver of Insurance Co-Payments	92
Professional Courtesy	92
Appointment Charges	92
Prescribing Drugs and Devices	92
Professional and Contractual Relationships	92
Physician Ownership of a Health Facility	92
Ghost Surgery	92
Discipline Within Medicine	92
Physician Health and Wellness	92
Substance Abuse	92
Unethical Conduct by Members of the Health Professions	93
Ethical Issues Regarding HIV	93
Ethics and the Human Genome	93
Closing Comments	93
Patient Education	94
Legal and Ethical Issues	94
Summary of Scenario	94
Connections	95
Study Guide Connection:	95
Evolve Connection:	95
7 Medicine and Law	96
Learning Objectives	96
Vocabulary	97
Scenario	96
Jurisprudence and the Classifications of Law	98
Criminal Law	99
Misdemeanors	99
Felonies	99
Treason	99
Civil Law	99
Tort Law	99
Contract Law	99
Administrative Law	99
Anatomy of a Medical Professional Liability Lawsuit	100
What Constitutes a Valid Contract?	100
Breach of Contract	101
The Statute of Frauds	101
Preliminaries of Litigation	101
Preparing for Court	101
Interrogatories	101
Depositions	102
Subpoenas	102
Discovery	102
Preparing Witnesses and Testifying	102
Inside the Courtroom	103
Burden of Proof	103
Outcome of the Case	104
Arbitration	104
Medical Professional Liability and Negligence	104
The Four Ds of Negligence	105
Types of Damages	106
Standard of Care	106
Consent	106
Giving Consent to Medical Procedures	107
Statute of Limitations	108
Confidentiality	108
Law and Medical Practice	108
Legal Disclosure	109
Patient Self-Determination Act	109
Patient’s Bill of Rights	109
Affordable Care Act of 2010	110
Controlled Substances Act	110
The Uniform Anatomical Gift Act	112
The Health Insurance Portability and Accountability Act	112
The Occupational Safety and Health Act and the Bloodborne Pathogens Standard	113
General Duty Clause	113
Emergency Preparedness	113
Exposure Control Plan	114
OSHA Record-Keeping Regulations	114
Needlestick Safety and Prevention Act	115
OSHA Training Requirements	116
Hepatitis B Vaccination	116
Clinical Laboratory Improvement Amendments	116
Americans with Disabilities Act	117
HITECH Act of 2009	118
Closing Comments	119
Patient Education	119
Legal and Ethical Issues	119
Connections	123
Study Guide Connection:	123
Evolve Connection:	123
Unit Two Administrative Medical Assisting	124
8 Computer Concepts	124
Learning Objectives	124
Vocabulary	125
Scenario	124
Computer Basics	126
Getting Started	126
Processing Information	128
Types of Computers	128
Parts of the Computer	129
Microprocessor	129
Monitor	129
Keyboard	130
Mouse	130
Printer	130
Inside the Computer	130
Motherboard	130
Disk Drives	130
CD-ROM	131
Software	131
Modems	131
Speakers and Microphones	132
Peripheral Devices	132
Scanners	132
Digital Cameras	132
Flash Drives	132
External Hard Drives	132
Adding a Program to a Computer	132
File Formats	132
Computer Networking	133
Servers	133
The Internet	133
Browsers	134
Using a Phone to Perform Computer Functions	134
The Computer as a Co-Worker	134
Computer Security	135
HIPAA Regulations and Computers	135
Electronic Signatures	136
Computers and Ergonomics	136
Closing Comments	136
Patient Education	136
Legal and Ethical Issues	136
Summary of Scenario	137
Connections	138
Study Guide Connection:	138
Evolve Connection:	138
9 Telephone Techniques	139
Learning Objectives	139
Vocabulary	140
Scenario	139
Effective Use of the Telephone	140
Active Listening	140
Developing a Pleasing Telephone Voice	140
Holding the Telephone Handset Correctly	141
Maintaining Confidentiality	141
Thinking Ahead	142
Managing Telephone Calls	142
Answering Promptly	142
Identifying the Facility	142
Identifying the Caller	142
Screening Incoming Calls	143
Minimizing Wait Time	144
Transferring a Call	144
Taking a Telephone Message	145
Taking Action on Telephone Messages	146
Ending a Call	146
Retaining Records of Telephone Messages	146
Typical Incoming Calls	146
New Patients and Return Appointments	146
Directions	146
Inquiries about Bills	147
Inquiries about Fees	147
Participating Provider	147
Requests for Assistance with Insurance	147
Radiology and Laboratory Reports	147
Satisfactory Progress Reports from Patients	147
Routine Reports from Hospitals and Other Sources	147
Office Administration Matters	147
Requests for Referrals	147
Prescription Refills	148
Special Incoming Calls	148
Patients Refusing to Discuss Symptoms	148
Unsatisfactory Progress Reports	149
Requests for Test Results	149
Requests for Information from Third Parties	149
Complaints about Care or Fees	149
Calls from the Physician’s Family and Friends	149
Calls from Staff Members’ Family and Friends	149
Handling Difficult Calls	149
Angry Callers	149
Aggressive Callers	150
Unauthorized Inquiry Calls	150
Sales Calls	150
Physician Shopping	150
Complaints	150
Callers with Difficulty Communicating	150
Emergency Calls	150
Screening Guidelines	151
Getting the Information the Physician Needs	151
Typical Outgoing Calls	151
Telephone Services	151
Voice Mail	151
Answering Services	151
Automatic Call Routing	152
Call Forwarding	152
Caller ID	152
Caller ID Blocking	152
Cellular Phones	152
Fax Machines	152
Headsets	153
Using Long Distance and Special Services	153
Time Zones	153
International Service	153
Wrong Numbers	153
Conference Calls	153
Operator-Assisted Calls and Services	154
Office Telephone Equipment Needs	154
Number and Placement of Telephones	154
Using a Telephone Directory	155
Organizing a Personal Phone Directory	155
Identifying Community Resources	155
Closing Comments	155
Patient Education	155
Legal and Ethical Issues	155
Connections	157
Study Guide Connection:	157
Evolve Connection:	157
10 Scheduling Appointments	158
Learning Objectives	158
Vocabulary	159
Scenario	158
Using Established Priorities for Appointment Scheduling	159
Patient Needs	159
Physician Preferences and Habits	160
Available Facilities	160
Duration of Office Visits	160
Methods of Scheduling Appointments	160
Computer Scheduling	160
Appointment Book Scheduling	161
Self-Scheduling	161
Advance Preparation	161
Legality of the Appointment Book	161
Types of Appointment Scheduling	162
Open Office Hours	162
Scheduled Appointments	163
Flexible Office Hours	163
Wave Scheduling	164
Modified Wave Scheduling	164
Double-Booking	164
Grouping Procedures	164
Advance Booking	164
Time Patterns	164
Patient Wait Time	164
Telephone Scheduling	165
Scheduling Appointments for New Patients	165
Scheduling Appointments for Established Patients	166
In Person	166
By Telephone	166
Scheduling Other Types of Appointments	166
Inpatient Surgeries	167
Outpatient and Inpatient Procedure Appointments	167
Outside Visits	169
Special Circumstances	169
Late Patients	169
Rescheduling Canceled Appointments	169
Emergency Calls	169
Physician Referrals	171
Patients Without Appointments	171
Failed Appointments	171
No-Show Policy	172
Recording the Failed Appointment	172
Increasing Appointment Show Rates	172
Automated Call Routing	172
Appointment Cards	172
Confirmation Calls	172
E-Mail Reminders	172
Mailed Reminders	172
Handling Cancellations and Delays	172
When the Patient Cancels	172
When the Physician is Delayed	172
When the Physician Is Called to an Emergency	173
When the Physician Is Ill or Out of Town	173
Other Types of Appointments	174
Physicians	174
Pharmaceutical Representatives	174
Salespeople	174
Planning for the Next Day	174
Closing Comments	174
Patient Education	174
Legal and Ethical Issues	174
Connections	176
Study Guide Connection:	176
Evolve Connection:	176
11 Patient Reception and Processing	177
Learning Objectives	177
Vocabulary	178
Scenario	177
The Office Mission Statement	178
The Reception Area	178
Preparing for Patient Arrival	180
Preparing Medical Records	180
Greeting the Patient	181
Patient Check-In	181
Patient Interaction	182
Registration Procedures	183
Obtaining a Patient’s History	184
Showing Consideration for Patients’ Time	184
Patients with Special Needs	185
Escorting and Instructing the Patient	185
Medical Record Placement	185
Challenging Situations	186
Talkative Patients	186
Children	186
Angry Patients in the Reception Area	186
Patient’s Relatives and Friends	186
The Friendly Farewell	186
Patient Checkout	186
Closing Comments	187
Patient Education	187
Legal and Ethical Issues	187
Connections	189
Study Guide Connection:	189
Evolve Connection:	189
12 Office Environment and Daily Operations	190
Learning Objectives	190
Vocabulary	191
Scenario	190
The Office Policy and Procedures Manual	191
Using the Office Policy Manual	191
Opening the Office	193
Preparing for the Day Ahead	193
Patient Traffic Flow	194
Visitors to the Office	194
Daily, Weekly, and Monthly Duties	195
Constant Cleaning	195
Cleaning Services	195
Filing	195
Supplies and Equipment in the Physician’s Office	195
Identifying the Need for Specific Supplies	196
Budgeting	196
Comparing Prices	196
Ordering Supplies	198
Replenishing Supplies	199
Ordering Equipment	199
Receiving an Order	200
Warranty Information	200
Invoices and Statements	200
Troubleshooting Equipment Failure	200
Equipment Maintenance	200
Preventing Waste	200
Lunch and Break Times	201
Sending and Receiving E-Mail	202
Internet Research	202
Traveling for Business Purposes	202
Seminars and Workshops	203
Scheduling Travel, Hotel Rooms, and Car Rentals	203
Travel Receipts	203
Basic Safety and Security in the Medical Office	204
Suspicious Persons	204
Robbery	204
Office Security	204
Smoke Alarms and Fire Extinguishers	204
Fire Exits and Exit Routes	205
Emergency Preparedness	205
Evacuating the Health Facility	207
Waste Storage and Destruction	207
Ergonomics	208
Identifying and Sharing Community Resources	210
Emergency Phone Numbers	210
Closing the Office	211
Closing Comments	211
Patient Education	211
Legal and Ethical Issues	212
Connections	213
Study Guide Connection:	213
Evolve Connection:	213
13 Written Communications and Mail Processing	214
Learning Objectives	214
Vocabulary	215
Scenario	214
Importance of Written Communications	215
Reflection on the Physician	215
Writing Skills and Composing Tips	216
Grammar Review	218
Parts of Speech	218
Nouns.	218
Pronouns.	218
Verbs.	218
Adjectives.	218
Adverbs.	218
Prepositions.	218
Conjunctions.	218
Interjections.	218
Making Sense of Sentences	218
Types of Sentences.	218
Sentence Structure.	218
Sentence Errors.	218
Personal Tools	218
Equipment and Supplies	218
Equipment	219
Computers	219
Copiers	219
Scanners	219
Printers	219
Supplies	219
Stationery	219
Sizes and Types of Letterhead Paper.	219
Continuation Pages.	219
Envelopes.	219
Letter Styles	219
Block Letter Style	219
Modified Block Letter Style	219
Modified Block Letter Style with Indented Paragraphs	219
Simplified Letter Style	219
Types of Punctuation for Letter Styles	220
Spacing and Margins	221
The Parts of a Letter	222
Heading	222
Opening	222
Body	222
Closing	222
Postscripts	223
Continuation Pages	223
Signing the Letter	223
Other Types of Written Communication	223
Telephone Messages	223
E-Mail and Text Messages	223
Faxed Messages	224
Memorandums	224
Editing	224
Developing a Portfolio	225
U.S. Postal Service	225
Mail Processing	225
Incoming Mail	225
Opening the Mail	226
Annotating	226
Responding to the Mail	227
Mail Requiring Special Handling	227
Payment Receipts	227
Insurance Information	228
Drug Samples	228
Vacation Mail	228
Outgoing Mail	228
Addressing the Envelope	228
Delivery Addresses.	228
Return Addresses.	230
Notations.	230
Sealing and Stamping Hints	230
Cost-Saving Mailing Procedures	230
Using ZIP Codes.	230
Presorting.	231
Using Correct Postage.	231
Getting Faster Mail Service	231
Postage Meters.	231
Mailing Practices.	231
Classifications of Mail	231
Express Mail.	231
First-Class Mail.	231
Priority Mail.	231
Standard Mail.	231
Media Mail.	232
Business Mail.	232
Nonprofit Mail.	232
Special Services	232
Insured Mail.	232
Registered Mail.	232
Postal Money Orders.	233
Special Delivery.	233
Special Handling.	233
Certified Mail.	233
Certificate of Mailing.	233
Private Delivery Services	233
Handling Special Situations	233
Forwarding and Obtaining a Changed Address.	233
Recalling Mail.	233
Returned Mail.	234
Tracing Lost Mail.	234
Using Mail Merge	234
Closing Comments	234
Patient Education	234
Legal and Ethical Issues	234
Connections	236
Study Guide Connection:	236
Evolve Connection:	236
Unit Three Health Information in the Medical Office	237
14 The Paper Medical Record	237
Learning Objectives	237
Vocabulary	238
Scenario	237
The Importance of Accurate Medical Records	238
Ownership of the Medical Record	239
Creating an Efficient Medical Records Management System	240
Types of Records	240
Organization of the Medical Record	240
Source-Oriented Records	240
Problem-Oriented Medical Records	240
Contents of the Complete Case History	242
Subjective Information	242
Personal Demographics	242
Personal and Medical History	242
Patient’s Family History	242
Patient’s Social History	242
Patient’s Chief Complaint	242
Objective Information	243
Physical Examination Findings and Laboratory and Radiology Reports	243
Diagnosis	243
Treatment Prescribed and Progress Notes	243
Condition at the Time of Termination of Treatment	244
Obtaining the History	244
The Medical Assistant’s Role	244
Making Additions to the Patient’s Record	246
Laboratory Reports	246
Radiology Reports	247
Progress Notes	247
Making Corrections and Alterations to Medical Records	247
Keeping Records Current	248
Transfer, Destruction, and Retention of Medical Records	249
Regular Transfer of Files	249
Retention and Destruction	250
Protection of Records	250
Long-Term Storage	250
Releasing Medical Record Information	250
Dictation and Transcription	252
Voice Recognition Software	253
Filing Equipment	253
Drawer Files	253
Shelf Files	253
Rotary Circular Files	253
Lateral Files	253
Compactable Files	253
Automated Files	253
Card Files	253
Special Items	254
Filing Supplies	254
Divider Guides	254
OUTguides	254
File Folders	254
Labels	255
Filing Procedures	255
Conditioning	255
Releasing	255
Indexing and Coding	255
Sorting	256
Storing and Filing	256
Locating Misplaced Files	256
Indexing Rules	256
Filing Methods	257
Alphabetic Filing	257
Numeric Filing	257
Subject Filing	259
Color-Coding	259
Alphabetic Color-Coding	259
Numeric Color-Coding	259
Other Color-Coding Applications	259
Organization of Files	259
Health-Related Correspondence	259
General Correspondence	260
Practice Management Files	260
Miscellaneous Files	260
Tickler or Follow-Up Files	260
Transitory or Temporary File	260
Closing Comments	261
Patient Education	261
Legal and Ethical Issues	261
Connections	263
Study Guide Connection:	263
Evolve Connection:	263
15 The Electronic Medical Record	264
Learning Objectives	264
Vocabulary	265
Scenario	264
Executive Order to Promote Interoperability of EMR Systems	265
Technologic Terms in Health Information	265
American Recovery and Reinvestment Act (ARRA)	266
HITECH Act and Meaningful Use	266
Advantages and Disadvantages of the EMR	267
Incentives for Implementing EMR Systems	268
Capabilities of EMR Systems	268
Patients’ Concerns About the EMR	270
Making Additions and Corrections to the EMR	270
Nonverbal Communication with the Patient When Using the EMR	270
The Nationwide Health Information Network	272
Backup Systems for the EMR	272
The Medical Assistant and the EMR	273
Closing Comments	273
Patient Education	273
Legal and Ethical Issues	273
Connections	275
Study Guide Connection:	275
Evolve Connection:	275
Reference	275
16 Health Information Management	276
Learning Objectives	276
Vocabulary	277
Scenario	276
Evolution of the Profession	277
Health Information Certifications	277
Uses of Healthcare Data	279
What are High-Quality Data?	279
Challenges of Quality Assurance Problems	280
National Center for Health Statistics	281
Total Quality Management	281
The Concept of Total Quality Management	282
The Joint Commission	282
Risk Management	282
Acknowledging and Disclosing Medical Errors	283
Closing Comments	285
Patient Education	285
Legal and Ethical Issues	286
Connections	287
Study Guide Connection:	287
Evolve Connection:	287
Reference	287
Bibliography	287
17 Privacy in the Physician’s Office	288
Learning Objectives	288
Vocabulary	289
Scenario	288
Health Insurance Portability and Accountability Act	289
Effect of the HIPAA Privacy Rule	290
Title I and Title II Provisions	290
Provisions of Administrative Simplification	290
Patients’ Rights	290
Right to Notice of Privacy Practices	291
Right to Access Protected Health Information	292
Right to Request Restrictions on Certain Uses and Disclosures of Protected Health Information	292
Right to Request Confidential Communications	292
Right to Request Amendment of Protected Health Information	292
Right to Receive an Accounting of Disclosures of Protected Health Information	292
Responsibilities of Providers or Health Plans	293
HIPAA and Electronic Fund Transfers	293
Permission to Disclose Protected Health Information	294
Identifying the Patient	294
Patients’ Names and Sign-In Sheets	294
Placement of Patient Medical Records	295
Children’s Health Records	296
Discussing Information with Family and Friends	297
Telephone Messages and Faxes	297
Emergencies	298
Complaints About Privacy Violations	298
HIPAA and Emergency Preparedness	298
Closing Comments	299
Patient Education	300
Legal and Ethical Issues	300
Summary of Scenario	301
Connections	302
Study Guide Connection:	302
Evolve Connection:	302
Unit Four Billing and Coding Procedures	303
18 Basics of Diagnostic Coding	303
Learning Objectives	303
Vocabulary	304
Scenario	303
Getting to Know the ICD-9-CM	305
What Is Diagnostic Coding?	305
Why Use ICD-9-CM Codes?	305
Evolution of ICD Coding	306
ICD-9-CM Codes	306
Structure of the ICD-9-CM	306
Tabular Index (Volume 1)	307
Supplemental Classifications	307
V Codes.	307
E Codes.	307
Appendixes	307
Conventions Used in the Tabular Index	308
Abbreviations.	308
Punctuation.	308
Symbols.	309
Other Conventions.	309
Instructional Notations.	309
Related Terms	309
Alphabetic Index (Volume 2)	309
Supplementary Sections of the Alphabetic Index	310
Procedures (Volume 3)	310
Beginning the Coding Process	310
Medical Documentation	310
Encounter Form	310
Treatment or Progress Notes	310
History and Physical Exam	310
Discharge Summary	310
Operative Report	311
Radiology, Laboratory, or Pathology Report	311
Extracting Diagnostic Statements	311
Main and Modifying Terms	311
Steps in ICD-9-CM Coding	312
Using the Alphabetic Index (Volume 2)	312
Using the Tabular Index (Volume 1)	312
Diagnostic Coding Decision Tree	314
Special Coding Instructions	316
Coding of Signs and Symptoms	316
Coding Suspected Conditions	316
Multiple Coding	316
Using Combination Codes	316
Coding Late Effects and the Past Medical History	316
Coding Impending or Threatened Conditions	316
Coding Infectious and Parasitic Diseases	317
Coding Organism-Caused Diseases	317
Human Immunodeficiency Virus (HIV) Infection and Acquired Immunodeficiency Syndrome (AIDS)	318
Coding Complications of Care	318
Coding the Etiology and Manifestation	318
Coding Neoplasms	318
Terms Defining Malignant Neoplasm Sites	319
Definitions of Benign, Uncertain Behavior, and Unspecified Nature Neoplasms	319
Five Steps for Coding Neoplasms	319
Coding for the Circulatory System	319
Myocardial Infarction	319
Arteriosclerotic Cardiovascular Disease	319
Hypertensive Disease	319
Coding for Complications of Pregnancy, Childbirth, and the Puerperium	320
Obstetric Coding Guidelines	320
Cesarean Delivery	321
Outcome of Delivery and Liveborn Infant Codes	321
Newborn Coding	321
Liveborn Infant Category	321
Coding Injuries	321
Coding Fractures	321
Burns	321
Steps for Coding Burns	322
Using E Codes	322
Table of Drugs and Chemicals	322
E Codes Used with the Table of Drugs and Chemicals	323
V Codes: Classification of Factors Influencing Health Status and Contact with Health Service	323
V Code Index for History Codes	323
Diabetes Mellitus	323
Maximizing Third-Party Reimbursement	323
Closing Comments	324
Patient Education	324
Legal and Ethical Issues	324
Connections	325
Study Guide Connection:	325
Evolve Connection:	325
19 Basics of Procedural Coding	326
Learning Objectives	326
Vocabulary	327
Scenario	326
Getting to Know the CPT	328
The Evolution of CPT Coding	328
Purpose of CPT Procedural Coding	328
The CPT Code	328
Category I Codes	328
Product Pending U.S. Food and Drug Administration Approval	328
Bundled Codes	328
Unbundled Codes	328
Category II	328
Category III	329
Modifiers	329
Format of the CPT Coding Manual	329
CPT Content	329
The Indexes	330
Main Text	330
Evaluation and Management Section	330
Anesthesia Section	330
Surgery Section	330
Radiology Section	331
Pathology and Laboratory Section	331
Medicine Section	331
Conventions of the CPT Main Text	331
Guidelines	332
Notes	332
Unlisted Procedure or Service Code	332
Special Reports	332
Appendixes	332
Beginning the Coding Process	333
Medical Documentation	333
Using the Alphabetic Index	333
Searching the Alphabetic Index	334
Using See and See Also in the Alphabetic Index	335
Use of the Semicolon	335
Stand-Alone Codes and Code Ranges	335
Steps for Using the Alphabetic Index	335
Using the Tabular Index (Main Text)	335
Steps for Using the Main Text (Tabular Index)	336
Coding Decision Tree	336
Surgery Coding	337
General	337
Surgical Package Definition	337
Integumentary System	337
Excision of Lesions—Benign or Malignant	337
Repair (Closure)	337
Instructions for Listing Services for Wound Repair	337
Musculoskeletal System	338
Fractures	338
Cardiovascular System	339
Grafting for Coronary Bypass	339
Venous Grafts	339
Arterial Grafts	339
Maternity Care and Delivery	339
Understanding Evaluation and Management	339
Identifying the Place of Service	339
Identifying the Patient Status	339
Determining the Level of Service Provided	339
Key Components and Contributing Factors	339
History.	339
Levels of History	340
Examination.	340
Levels of Examination.	340
Medical Decision Making.	340
Number of Diagnoses and Management Options.	342
Amount and Complexity of Data Reviewed.	342
Risk of Complications and Morbidity or Mortality.	342
Medical Decision Making Complexity Levels.	342
Contributing Factors	342
Counseling.	342
Nature of Presenting Problem.	342
Coordination of Care.	342
Time.	342
Anesthesia Coding	342
Anesthesia Formula	343
Basic Unit Value (B)	343
Time Unit (T)	343
Modifying Unit (M)	344
Qualifying Circumstances (QC).	344
Physical Status Modifiers.	344
Conversion Factors	344
Calculating Anesthesia Services	344
Radiology Coding	344
Pathology and Laboratory Section	345
Coding for the Medicine Section	345
Immune Globulins	345
Immunization Administration for Vaccines or Toxoids	345
Vaccines/Toxoids	345
Hydration, Therapeutic, Prophylactic, and Diagnostic Injections and Infusion	345
Home Health Procedures and Services	346
Healthcare Common Procedure Coding System (HCPCS)	346
Coding Levels: CPT and HCPCS	346
HCPCS Codes	346
HCPCS Manual	346
Closing Comments	347
Patient Education	348
Legal and Ethical Issues	349
Connections	350
Study Guide Connection:	350
Evolve Connection:	350
20 Basics of Health Insurance	351
Learning Objectives	351
Vocabulary	352
Scenario	351
The Purpose of Health Insurance	353
Impact of Insurance Billing on the Medical Office	353
Cycle of Health Insurance	354
Tasks Related to the Cycle of Health Insurance	354
Determining Primary and Secondary Coverage	354
Cost of Coverage	354
Types of Health Insurance	355
Group Policies	355
Individual Policies	355
Government Plans	355
TRICARE	355
Medicaid	355
Medicare	355
Workers’ Compensation	355
Self-Insured Plans	355
Medical Savings Account	356
Types of Insurance Benefits	356
Hospitalization	356
Surgical	356
Basic Medical	356
Disability (Loss of Income) Protection	357
Dental Care	357
Vision Care	357
Medicare Supplement	358
Special Risk Insurance	358
Liability Insurance	358
Life Insurance	358
Long-Term Care Insurance	358
How Benefits are Determined	358
Indemnity Schedules	358
Service Benefit Plans	358
Resource-Based Relative Value Scale	358
Usual, Customary, and Reasonable Fee	359
Health Insurance Providers	359
Managed Care	359
Managed Care Policies and Procedures	360
Models of Managed Care	360
Health Maintenance Organization.	360
Independent Practice Association.	360
Staff Model.	360
Group Model.	360
Exclusive Provider Organization.	360
Preferred Provider Organizations.	360
Blue Cross/Blue Shield	361
Medicaid	361
Medicare	362
Medicare Part A	362
Medicare Part B	362
Medicare Advantage (formerly Medicare + Choice)	363
Medicare Part D	363
TRICARE	363
CHAMPVA	363
Workers’ Compensation	363
Disability Programs	363
Commercial Insurance	364
Understanding Insurance Plan Requirements	364
Utilization Management/Utilization Review	364
Verification of Insurance Benefits	365
Precertification and Preauthorization	366
Fee Schedules	370
Resource-Based Relative Value Scale	370
Deductibles and Co-Insurance	370
Patient Education	371
Legal and Ethical Issues	371
Closing Comments	372
Connections	374
Study Guide Connection:	374
Evolve Connection:	374
21 The Health Insurance Claim Form	375
Learning Objectives	375
Vocabulary	376
Scenario	375
Types of Claims	376
Hard Copy (Paper) Claims	376
Advantages and Disadvantages of Paper Claims	376
Intelligent Character Recognition	377
Electronic Claims	377
Electronic Claims Submission	378
Direct Billing.	378
Clearinghouse Submission.	378
Advantages of Electronic Submission	378
Data Gathering Guidelines	378
Verification of Eligibility and Benefits	378
Preauthorization and/or Referral	382
Completing the CMS-1500 Form	382
Section 1: Carrier Block	382
Section 2: Patient/Insured Section—Blocks 1 to 8 (Figure 21-3)	382
Section 3: Patient/Insured Section—Blocks 9 to 13 (Figure 21-4)	389
Physician/Supplier Section—Blocks 14 to 23 (Figure 21-5)	390
Physician/Supplier Section—Blocks 24 to 33 (Figure 21-6)	391
Guidelines for Claims Review before Submission	393
Preventing Claim Rejection	393
Denied or Rejected Claims	393
Explanation of Benefits	393
Checking a Claim’s Status	394
Audit Trails	394
Patient Education	396
Legal and Ethical Issues	396
Closing Comments	396
Connections	398
Study Guide Connection:	398
Evolve Connection:	398
22 Professional Fees, Billing, and Collecting	399
Learning Objectives	399
Vocabulary	400
Scenario	399
How Fees are Determined	400
Impact of Managed Care	400
Prevailing Rate in the Community	400
Usual, Customary, and Reasonable Fees	401
Fee Setting by Third-Party Payers	401
Physician’s Fee Profile	401
Insurance Allowance	401
Explaining Fees to Patients	401
Discussion of Fees in Advance	402
Explanation of Additional Fees	402
Fee Estimates	402
The Guarantor’s Ultimate Responsibility	402
Charging the Patient for Medical Services and Procedures	402
Computations Used on Patient Accounts	403
Comparison of Manual and Computerized Bookkeeping Systems	404
Computerized Bookkeeping Systems	404
Manual Bookkeeping Systems	405
Preparing Patient Accounts for Daily Transactions	406
Entering and Posting Transactions	406
Posting Other Payments and Charges	406
Summarizing Accounting Transactions	406
Special Bookkeeping Entries	407
Adjustments	407
Credit Balances	407
Refunds	409
Insufficient Funds Checks	410
Balancing the Accounts Receivable and Accounts Receivable Control	411
Payment Options	411
Payment at the Time of Service	411
Billing after Payment Arrangements	411
Using Credit for Medical Services	411
Truth in Lending Act	412
Fair Debt Collection Practices Act	412
Obtaining Credit Information	412
Insurance or Other Third-Party Payers	413
Billing Procedures	413
Computer-Generated Statements	414
Encounter Forms	414
Photocopied Statements	414
Online Billing Statements	414
Itemizing the First Statement	414
Time and Frequency of Billing	414
Once-a-Month Billing	414
Cycle Billing	414
Professional Courtesy	415
Billing Minors	415
Collection Procedures	415
Medical Care for Those Who Cannot Pay	415
Fees in Hardship Cases	416
Pitfalls of Fee Adjustments	416
Medicare and Advance Beneficiary Notices	416
Preparing Accounts for Collection Activity	416
Collection Techniques	416
Telephone Collection Calls	416
Collection Letters or Reminders	419
Personal Interviews	419
Special Collection Situations	419
Tracing “Skips”	419
Address Change Service.	419
Claims Against Estates	420
Bankruptcy	420
Using Outside Collection Services	421
Using a Collection Agency	421
Working with the Collection Agency	421
Posting Collection Agency Payments	421
Making the Decision to Sue	422
Small Claims Court	422
Closing Comments	422
Patient Education	423
Legal and Ethical Issues	423
Connections	424
Study Guide Connection:	424
Evolve Connection:	424
Unit Five Financial and Practice Management	425
23 Banking Services and Procedures	425
Learning Objectives	425
Vocabulary	426
Scenario	425
Banking in Today’s Business World	426
Online Banking	426
Online Convenience	426
Customer-Oriented Banking	427
Electronic Funds Transfers	427
Checks	427
Debit Cards	427
Types of Checks	428
Bank Draft	428
Cashier’s Check	428
Limited Check	428
Money Order	428
Traveler’s Check	428
Voucher Check	428
The Banking System	429
The Federal Reserve	429
Routing and Account Numbers	429
American Bankers Association Number	429
How Checks Are Processed	429
Clearinghouses	429
Magnetic Ink Character Recognition	429
Bank Accounts	430
Common Types of Accounts	430
Checking Accounts	430
Savings Accounts	430
Interest-Bearing Accounts	430
Money Market Savings Account	430
Individual Retirement Accounts	430
The Business Account	430
What to Look for in a Business Account	430
Perks for Businesses	430
Business Checks	431
Computer-Generated Checks.	432
One-Write Check Writing.	432
Bill Paying and Check Writing	432
Establishing a Bill-Paying System	432
Designated Times	433
Paying Bills to Maximize Money	433
Automatic Withdrawals and Deductions	433
Online Bill Paying	433
Writing Checks	433
Instructions	433
Checkbook Stubs	434
Signing Checks	434
Handling Corrections	434
Writing Cash Checks	434
Mailing Checks	435
Special Problems with Checks	435
Overdraws or Overdrafts	435
Stop-Payments	435
Precautions for Accepting Checks	435
Acknowledging Payment in Full	435
Precautions for Accepting Credit and Debit Cards	436
Returned Checks	436
Charging Fees	436
Legal Options	436
Endorsements	437
Why an Endorsement Is Necessary	437
Types of Endorsements	437
Blank Endorsement	437
Restrictive Endorsement	437
Special Endorsement	437
Qualified Endorsement	437
Methods of Endorsement	437
Stamp	437
Signature	437
Making Deposits	437
Preparing the Deposit	438
Direct Deposits	439
Other Methods of Deposit	439
Bank Statements and Reconciliation	439
Mailed Statements	439
Online Statements	439
Reconciling the Bank Statement	439
Signature Cards	440
Bonding	440
Closing Comments	441
Patient Education	441
Legal and Ethical Issues	442
Connections	443
Study Guide Connection:	443
Evolve Connection:	443
24 Financial and Practice Management	444
Learning Objectives	444
Vocabulary	445
Scenario	444
What is Accounting?	445
Accounting Bases	445
Financial Summaries	445
The Rules of Bookkeeping	446
Kinds of Financial Records	447
Daily Journal	447
Checkbook	447
Disbursements Journal	448
Petty Cash Records	448
Accounting Systems	448
End of Day Summarizing	448
Trial Balance of Accounts Receivable	449
Locating and Preventing Errors	449
Accounts Payable Procedures	449
Invoices and Statements	449
Paying for Purchases	450
Recording Disbursements	450
Accounting for Petty Cash	450
Common Periodic Financial Reports	451
Recent Legislation for Small Businesses and Their Expenses	451
Payroll Records	451
Payroll Reporting Forms	451
Income Tax Withholding	452
Employers Income Tax	453
Social Security, Medicare, and Income Tax Withholding	453
Quarterly Returns	453
Annual Returns	453
Federal Unemployment Tax	453
State Unemployment Taxes	453
State Disability Insurance	453
Budgets	453
Insurance	454
Closing Comments	454
Patient Education	454
Legal and Ethical Issues	454
Connections	456
Study Guide Connection:	456
Evolve Connection:	456
25 Medical Practice Management and Human Resources	457
Learning Objectives	457
Vocabulary	458
Scenario	457
Today’s Office Managers	458
Who’s in Charge?	458
Duties of the Medical Office Manager	459
The Power of Influence	459
The Manager as a Leader	459
Types of Leaders	460
Styles of Management	460
Theories X, Y, and Z	460
Maslow’s Hierarchy of Needs	460
Leading During Transitions and Change	461
The Role of Power	461
Abuse of Power and Authority	461
The Power of Motivation	461
The New Office Manager	462
Creating a Team Atmosphere	462
Use of Incentives and Employee Recognition	462
Problem Employees	463
Problem Patients	463
Preventing Burnout	463
Keeping the Management Relationship Professional	464
Laws Affecting Employment	464
Selecting the Right Staff Members	464
Understanding the Needs of the Office	465
Reviewing Resumés and Applications	465
Arranging the Personal Interview	465
The Interview	468
Follow-Up Activities	469
Making the Selection	470
Paperwork for New Employees	470
Orientation and Training: Critical Factors for Successful Employees	470
Job Description	471
Staff Development Training	471
Delegation of Duties	471
Using Performance Reviews Effectively	474
Peer Evaluations	477
Poor Evaluations Made Easier	477
Terminating Employees	477
Fair Salaries and Raises	479
Staff Meetings	479
Seeing the Whole Picture	479
Office Management Tools	480
Patient Information Booklet	480
Financial Policy Folder	481
Patient Instruction Sheets	481
Medical Practice Acts	481
Physician Licensure and Registration	482
Licensure	482
Examination	482
Reciprocity	482
Endorsement	482
Exemptions	482
Registration and Reregistration	482
Revocation or Suspension	482
Closing Comments	482
Patient Education	483
Legal and Ethical Issues	483
Connections	484
Study Guide Connection:	484
Evolve Connection:	484
26 Medical Practice Marketing and Customer Service	485
Learning Objectives	485
Vocabulary	486
Scenario	485
Developing Marketing Strategies	486
Branding	486
Knowing the Target Market	487
Ethics, Marketing, and Public Relations	487
The Four Ps	487
Deciding What Services to Offer	487
Developing a Plan for Marketing	488
Promoting the Practice	488
Tapping into Free Community Resources	488
Advertising Plans and Agencies	489
Communication as a Marketing Tool	489
Promoting a New Practice	489
Developing and Giving Presentations	489
Overcoming Anxiety	490
During the Presentation	490
Building a Practice Web Site	492
Defining Objectives	492
Designing Pages	492
Locating a Web Server	492
Uploading Pages	492
Evaluating the Web Site	493
Social Media and Networking	493
High-Quality Customer Service in the Medical Practice	493
Treating the Patient as a Customer	493
Helpful Attitude	494
Phrases That Undermine Successful Customer Service	494
Identifying with Patients	494
What Do Patients Expect?	494
Remembering the Internal Customer	494
Closing Comments	495
Patient Education	495
Legal and Ethical Issues	495
Summary of Scenario	495
Connections	497
Study Guide Connection:	497
Evolve Connection:	497
Unit Six Fundamentals of Clinical Medical Assisting	498
27 Infection Control	498
Learning Objectives	498
Vocabulary	499
Scenario	498
Disease	499
The Chain of Infection	500
The Inflammatory Response	502
Types of Infections	502
Acute Infection	502
Chronic Infection	503
Latent Infection	503
Opportunistic Infections	503
Osha Standards for the Healthcare Setting	503
Exposure Control Plan	503
OSHA’s Bloodborne Pathogens Standard	503
Compliance Guidelines	504
Barrier Protection	504
Environmental Protection	505
Housekeeping Controls	509
Hepatitis B Vaccination	510
Postexposure Follow-Up	510
Aseptic Techniques: Prevention of Disease Transmission	512
Hand Washing	512
Sanitization	512
Ultrasonic Sanitization	514
Disinfection	514
Sterilization	516
Role of the Medical Assistant in Asepsis	516
Closing Comments	516
Patient Education	516
Legal and Ethical Issues	516
Connections	518
Study Guide Connection:	518
Evolve Connection:	518
28 Patient Assessment	519
Learning Objectives	519
Vocabulary	520
Scenario	519
Medical History	520
Collecting the History Information	520
Components of the Medical History	521
Understanding and Communicating with Patients	521
Sensitivity to Diversity	521
Therapeutic Techniques	524
Active Listening Techniques	524
Nonverbal Communication	525
Environmental Factors	526
Open-Ended Questions or Statements	526
Closed Questions	526
Interviewing the Patient	526
Interview Barriers	527
Providing Unwarranted Assurance	527
Giving Advice	528
Using Medical Terminology	528
Leading Questions	528
Talking Too Much	528
Defense Mechanisms	528
Communication Across the Lifespan	529
Recognizing and Responding to Verbal and Nonverbal Communications	530
Assessing the Patient	530
Signs and Symptoms	531
Documentation	531
Medical Terminology	533
Charting Methods	533
Problem-Oriented Medical Record	533
Source-Oriented Medical Record	538
Electronic Health Records	538
Closing Comments	539
Patient Education	539
Legal and Ethical Issues	539
Important Provisions of the Health Insurance Portability and Accountability Act	539
Connections	541
Study Guide Connection:	541
Evolve Connection:	541
29 Patient Education	542
Learning Objectives	542
Scenario	542
Patient Education and Models of Health and Illness	543
Patient Factors that Affect Learning	545
Perception of Disease Versus Actual State of Disease	545
Patient’s Need for Information	545
Patient’s Age and Developmental Level	545
Patient’s Mental and Emotional State	545
Influence of Multicultural and Diversity Factors on Patient Education	545
Patient Learning Style	546
Impact of Physical Disabilities	546
The Teaching Plan	547
Assess the Patient’s Learning Needs	547
Determine the Teaching Priorities	548
Decide on the Appropriate Teaching Materials	548
Decide on the Appropriate Teaching Methods	549
Implement the Teaching Plan	550
Closing Comments	551
Legal and Ethical Issues	551
HIPAA Applications	551
Connections	553
Study Guide Connection:	553
Evolve Connection:	553
30 Nutrition and Health Promotion	554
Learning Objectives	554
Vocabulary	555
Scenario	554
Nutrition and Dietetics	556
Nutrients	556
Nutrient Components	557
Carbohydrates	557
Recommendations for Carbohydrate Consumption	558
Fats	558
Saturated and Unsaturated Fatty Acids.	559
Foods High in Saturated Fat.	559
Cholesterol.	559
Recommendations for Fat Consumption	560
Antioxidants.	560
Proteins	560
Recommendations for Protein Consumption	561
Vitamins (Micronutrients)	561
Minerals (Electrolytes)	562
Water	568
Choose Myplate	568
Nutritional Status Assessment	569
Body Fat Measurement	569
Body Mass Index	570
Therapeutic Nutrition	571
Modifying a Diet	571
Liquid Diet	571
Soft or Light Diet	571
Mechanical Soft Diet	571
Bland Diet	571
Elimination Diet	571
High- or Low-Fiber Diet	572
Diabetic Diet	572
Heart-Healthy Diet	574
Reading Food Labels	575
How to Use Label Information	576
Organic Foods Production Act	577
Food-Borne Diseases	577
Food Contaminants	577
Eating Disorders	577
Obesity	578
Medications for Obesity	578
Health Promotion	578
Exercise	579
Stress Management	579
Health Screening	579
Closing Comments	579
Patient Education	579
Legal and Ethical Issues	580
Connections	581
Study Guide Connection:	581
Evolve Connection:	581
31 Vital Signs	582
Learning Objectives	582
Vocabulary	583
Scenario	582
Factors That May Influence Vital Signs	583
Temperature	584
Physiology	584
Fever	584
Temperature Readings	584
Types of Thermometers and Their Uses	585
Digital Thermometer	585
Tympanic Thermometer	587
Temporal Artery Scanner	587
Axillary Thermometer	587
Disposable Thermometer	588
Cleaning Thermometers	588
Digital Thermometers	588
Tympanic Thermometers	591
Disposable Thermometers	591
Pulse	591
Pulse Sites	591
Characteristics of a Pulse	593
Rate	593
Rhythm	594
Volume	594
Determining the Pulse Rate	594
Radial and Apical Pulse Rates	594
Femoral, Popliteal, and Pedal Pulses	595
Respiration	596
Physiology	596
Characteristics of Respirations	596
Counting Respirations	597
Blood Pressure	598
Factors That Affect Blood Pressure	598
Evaluating the Blood Pressure	598
Measuring Blood Pressure	599
Korotkoff Sounds	602
Phase I	602
Phase II	602
Phase III	602
Phase IV	602
Phase V	603
Palpatory Method	603
Anthropometric Measurement	603
Measuring Weight and Height	603
Weight	603
Height	605
Closing Comments	605
Patient Education	605
Legal and Ethical Issues	606
Connections	607
Study Guide Connection:	607
Evolve Connection:	607
32 Assisting with the Primary Physical Examination	608
Learning Objectives	608
Vocabulary	609
Scenario	608
Anatomy and Physiology	609
Structural Development	609
Cells	609
Tissues	609
Organs	610
Systems	610
Primary Care Physician	610
Physical Examination	611
Preparing for the Physical Examination	611
Role of the Medical Assistant in the Physical Examination	611
Room Preparation.	611
Patient Preparation.	612
Assisting the Physician.	613
Supplies and Instruments Needed for the Physical Examination	613
Ophthalmoscope.	613
Tongue Depressor.	613
Otoscope.	613
Nasal Speculum.	614
Tuning Fork.	614
Tape Measure.	615
Stethoscope.	615
Reflex Hammer.	615
Gloves.	615
Additional Supplies.	615
Assisting With the Physical Examination	615
Methods of Examination	615
Inspection.	615
Palpation.	615
Percussion.	615
Auscultation.	615
Mensuration.	615
Manipulation.	615
Positioning and Draping the Patient for the Physical Examination	616
Fowler’s Position.	616
Semi-Fowler’s Position.	616
Supine (Horizontal Recumbent) Position.	617
Dorsal Recumbent Position.	617
Lithotomy Position.	617
Sims’ Position.	619
Prone Position.	620
Knee-Chest Position.	620
Trendelenburg’s Position.	622
Principles of Body Mechanics	623
Transferring a Patient	625
Examination Sequence	625
Presenting Appearance (General Appearance)	626
Nutrition and Stature	626
Speech	626
Breath Odors	626
Skin	626
Head	626
Eyes	627
Ears	627
Nose and Sinuses	627
Mouth and Throat	627
Neck	627
Reflexes	627
Chest	627
Abdomen	627
Breast and Testicles	628
Rectum	628
Role of the Medical Assistant	628
Closing Comments	629
Patient Education	629
Legal and Ethical Issues	630
HIPAA Applications	630
Connections	632
Study Guide Connection:	632
Evolve Connection:	632
Unit Seven Assisting with Medications	633
33 Principles of Pharmacology	633
Learning Objectives	633
Vocabulary	634
Scenario	633
Government Regulation	634
Controlled Substances	635
Regulation of Controlled Substances	635
Drug Abuse	636
Drug Names	637
Approaches to Studying Pharmacology	637
Drug Reference Materials	637
Package Inserts	638
Physicians’ Desk Reference	638
U.S. Pharmacopeia/National Formulary	638
Learning About Drugs	638
Dispensing Drugs	639
Prescription Drugs	639
Drug Interactions with the Body	644
Drug Absorption	644
Oral Route	644
Parenteral Route	644
Mucous Membrane Absorption	645
Topical Absorption	645
Drug Distribution	645
Drug Action	645
Drug Metabolism	646
Drug Excretion	646
Factors That Affect Drug Action	646
Body Weight	646
Age	646
Gender	647
Time of Day	647
Pathologic Factors	647
Immune Responses	647
Psychological Factors	647
Tolerance	647
Accumulation	647
Idiosyncrasy	648
Drug-Drug Interactions	648
Classifications of Drug Actions	648
Examples of Drug Classifications	648
Adrenergics	648
Adrenergic Blockers	648
Analgesics	649
Anesthetics	649
Antacids	649
Antianxiety Agents	649
Antibiotics	649
Anticholinergics	649
Anticoagulants	649
Anticonvulsants	649
Antidepressants	649
Antiemetics	649
Antifungals	650
Antihistamines	650
Antihypertensive Agents	650
Anti-inflammatory Agents	650
Antimigraine Agents	650
Antineoplastics	650
Antipsychotics	650
Antipruritics	650
Antipyretics	650
Antispasmodics	650
Antitussives	650
Antiviral Agents	651
Bronchodilators	651
Cathartics (Laxative)	651
Central Nervous System Stimulants	651
Contraceptives	651
Decongestants	651
Diuretics	651
Expectorants	651
Hematopoietic Agents	651
Hemostatic Agents	651
Hormone Replacement Agents	651
Hypnotics (Sedatives)	651
Lipid-Lowering Agents	652
Miotics	652
Mydriatic Agents (Anticholinergic)	652
Narcotics	652
Oral Hypoglycemic Agents	652
Osteoporosis Agents	652
Herbal and Alternative Therapies	652
Herbal Products	652
Regulation of Herbal Products	652
Commonly Used Herbal Products	653
Alternative Therapies	653
Acupuncture	653
Chiropractic Care	653
Mind-Body Therapy	655
Homeopathic Medicine	655
Closing Comments	655
Patient Education	655
Therapeutic Communication With Patients From Diverse Cultures	655
Legal and Ethical Issues	656
HIPAA Applications	656
Connections	657
Study Guide Connection:	657
Evolve Connection:	657
34 Pharmacology Math	658
Learning Objectives	658
Vocabulary	659
Scenario	658
Drug Labels	659
Math Basics	659
Fractions	660
Decimals	661
Percent	661
Ratio and Proportion	661
Rounding Calculations	661
Systems of Measurement	662
Metric System	662
Rules for Metric System Conversions	663
Apothecary System	663
Household Measurements	664
Conversions Among Systems of Measurement	665
Calculating Drug Dosages for Administration	666
Calculating Dosages	666
Problem 1: Preparing an Injectable Dose.	666
Problem 2: Determining an Oral Dose.	667
More Sample Problems	668
Problem 1.	668
Problem 2.	668
Pediatric Dosages	668
Calculating the Dose	668
Clark’s Rule	668
West’s Nomogram	668
Dosages Based on Body Weight	669
Unit Eight Assisting with Medical Specialties	713
36 Emergency Preparedness and Assisting with Medical Emergencies	713
Learning Objectives	713
Vocabulary	714
Scenario	713
Safety in the Healthcare Facility	714
Patient Safety	714
Employee Safety	714
Environmental Safety	716
Disposal of Hazardous Waste	718
Emergency Preparedness	719
Community Resources for Emergency Preparedness	719
Assisting with Medical Emergencies	721
Emergency Supplies	721
Defibrillators	722
Precautions for Automated External Defibrillators	723
General Rules for Emergencies	724
Telephone Screening	724
Management of On-Site Emergencies	725
Life-Threatening Emergencies	726
Unresponsive Patient	726
Cardiac Emergencies	729
Choking	730
Cerebrovascular Accident (Stroke)	732
Shock	734
Common Office Emergencies	734
Fainting (Syncope)	734
Poisoning	734
Animal Bites	737
Insect Bites and Stings	737
Asthma Attacks	737
Seizures	738
Abdominal Pain	738
Sprains and Strains	738
Fractures	738
Burns	739
Tissue Injuries	739
Nosebleeds (Epistaxis)	741
Head Injuries	741
Foreign Bodies in the Eye	741
Heat and Cold Injuries	741
Dehydration	741
Diabetic Emergencies	742
Closing Comments	742
Patient Education	742
Legal and Ethical Issues	742
Summary of Scenario	743
Connections	745
Study Guide Connection:	745
Evolve Connection:	745
37 Assisting in Ophthalmology and Otolaryngology	746
Learning Objectives	746
Vocabulary	747
Scenario	746
Examination of the Eye	747
Anatomy and Physiology of the Eye	747
The Eyeball	747
Vision	748
Disorders of the Eye	748
Refractive Errors	748
Hyperopia (Farsightedness).	749
Myopia (Nearsightedness).	749
Presbyopia.	749
Astigmatism.	749
Signs and Symptoms of Refractive Errors	749
Treatment of Refractive Errors	749
Strabismus	750
Nystagmus	750
Infections of the Eye	750
Disorders of the Eyeball	750
Corneal Abrasion	750
Cataract	751
Glaucoma	751
Macular Degeneration	752
Diagnostic Procedures	753
Distance Visual Acuity	753
Near Visual Acuity	755
Ishihara Color Vision Test	755
Treatment Procedures	756
Eye Irrigation	756
Instillation of Eye Medication	756
Aseptic Procedures in Ophthalmology	760
Examination of the Ear	760
Anatomy and Physiology of the Ear	760
Outer or External Ear	760
Middle Ear	761
Inner Ear	761
Disorders of the Ear	762
Hearing Loss	762
Otitis	763
Impacted Cerumen	764
Ménière’s Disease	764
Diagnostic Procedures	765
Tuning Fork Testing	765
Audiometric Testing	765
Aseptic Procedures in Otology	766
Treatment Procedures	766
Ear Irrigation	766
Instilling Otic Medications	769
Examination of the Nose and Throat	769
Closing Comments	769
Patient Education	769
Legal and Ethical Issues	772
HIPAA Applications	772
Americans With Disabilities Applications	772
Connections	774
Study Guide Connection:	774
Evolve Connection:	774
38 Assisting in Dermatology	775
Learning Objectives	775
Vocabulary	776
Scenario	775
Anatomy and Physiology	776
Epidermis	776
Dermis	776
Subcutaneous Layer	777
Diseases and Disorders	777
Skin Lesions	777
Infections	777
Bacterial Infections	777
Impetigo.	777
Acne.	779
Rosacea.	779
Furuncles and Carbuncles.	779
Cellulitis.	780
Fungal Infections (Dermatophytoses)	780
Viral Infections	781
Warts.	781
Herpes Simplex (Cold Sores).	781
Herpes Zoster (Shingles).	781
Other Infections	781
Scabies and Pediculosis.	781
Inflammatory and Autoimmune Disorders	783
Seborrheic Dermatitis	783
Contact Dermatitis	783
Eczema (Atopic Dermatitis)	783
Psoriasis	783
Systemic Lupus Erythematosus	784
Scleroderma	784
Thermal Injuries	784
Superficial-Thickness (First-Degree) Burn	784
Partial-Thickness (Second-Degree) Burn	784
Treatment of Minor Burns	785
Full-Thickness (Third-Degree) Burn	785
Cold Injuries	786
Benign and Malignant Neoplasms	786
Neoplasms of the Skin	787
Dermatologic Procedures	788
Assisting With a Dermatologic Examination	788
Skin Testing for Allergies	789
Percutaneous Test.	789
Patch Test.	789
Intradermal (Intracutaneous) Test.	789
Radioallergosorbent Test.	789
Treatment of Allergies	790
Obtaining a Wound Specimen for Culture	790
Appearance Modification Procedures	790
Chemical Peel (Chemexfoliation).	790
Dermabrasion.	790
Laser Resurfacing (Photothermolysis).	790
Botox Injections.	790
Closing Comments	790
Patient Education	790
Legal and Ethical Issues	791
Connections	793
Study Guide Connection:	793
Evolve Connection:	793
39 Assisting in Gastroenterology	794
Learning Objectives	794
Vocabulary	795
Scenario	794
Anatomy and Physiology	795
Diseases of the Gastrointestinal System	797
Characteristics of the GI System	797
Cancers of the Gastrointestinal Tract	798
Disorders of the Esophagus and Stomach	799
Hiatal Hernia	799
Gastroesophageal Reflux Disease	800
Gastric and Duodenal Ulcers	800
Pyloric Stenosis	801
Intestinal Disorders	802
Food Poisoning	802
Dumping Syndrome	802
Irritable Bowel Syndrome	802
Acute Appendicitis	803
Crohn’s Disease	803
Ulcerative Colitis	804
Celiac Disease	804
Diverticular Disease	804
Hernias of the Abdomen	805
Hemorrhoids	805
Diseases of the Liver and Gallbladder	805
Cirrhosis	805
Hepatitis	806
Viral Hepatitis	806
Diagnosis and Treatment	806
Cholelithiasis (Gallstones)	807
Signs and Symptoms	807
Diagnosis and Treatment	808
The Medical Assistant’s Role in the Gastrointestinal Examination	808
Assisting with the Examination	808
Diagnostic Procedures	809
Sigmoidoscopy and Colonoscopy Examinations	809
Laboratory Tests	810
Occult Blood Screening	810
Proctologic Examination	812
Closing Comments	813
Patient Education	813
Legal and Ethical Issues	813
Connections	815
Study Guide Connection:	815
Evolve Connection:	815
40 Assisting in Urology and Male Reproduction	816
Learning Objectives	816
Vocabulary	817
Scenario	816
Anatomy and Physiology of the Urinary System	817
Disorders of the Urinary System	818
Urinary Incontinence	818
Urinary Tract Infections and Inflammations	820
Urethritis	820
Cystitis	820
Pyelonephritis	820
Treatment of Urinary Tract Infections	820
Glomerulonephritis	821
Urinary Tract Disorders and Cancers	821
Renal Calculi	821
Hydronephrosis	821
Polycystic Kidneys	822
Bladder Cancer	822
Renal Carcinoma	823
Wilms’ Tumor	823
Renal Failure	823
Treatment	823
Pediatric Urologic Disorders	824
Nocturnal Enuresis	824
Urinary Reflux Disorder	825
Cryptorchidism	825
Anatomy and Physiology of the Male Reproductive System	826
Penis	826
Hormone Production	827
Disorders of the Male Reproductive Tract	827
Diseases of the Prostate	827
Prostatitis	827
Benign Prostatic Hyperplasia	827
Prostate Cancer	828
Pathologic Conditions of the Genital Organs	828
Epididymitis	828
Balanitis	828
Hydrocele	829
Testicular Cancer	829
Erectile Dysfunction	829
Infertility	829
Sexually Transmitted Infections	829
Bacterial Sexually Transmitted Infections	829
Viral Sexually Transmitted Infections	831
Acquired Immunodeficiency Syndrome	832
The Medical Assistant’s Role in Urologic and Male Reproductive Examinations	834
Assisting with a Urologic Examination	834
Assisting with a Male Reproductive Examination	834
Vasectomy	834
Closing Comments	835
Patient Education	835
Legal and Ethical Issues	835
HIPAA Applications	835
Connections	837
Study Guide Connection:	837
Evolve Connection:	837
41 Assisting in Obstetrics and Gynecology	838
Learning Objectives	838
Vocabulary	839
Scenario	838
Anatomy and Physiology	839
Female Reproductive System	839
Breast Tissue	840
Menstruation	840
Follicular Phase (Proliferative Phase)	840
Luteal Phase (Secretory Phase)	841
Menstrual Phase	841
Contraception	841
Barrier Methods	841
Hormonal Contraceptives	842
Intrauterine Devices	843
Permanent Methods	844
Gynecologic Diseases and Disorders	844
Menstrual Disorders and Conditions	844
Endometriosis	844
Infections	845
Candidiasis	845
Bacterial Vaginosis	845
Cervicitis	845
Pelvic Inflammatory Disease	846
Sexually Transmitted Infections	846
Benign Tumors	847
Fibroid Tumors	847
Ovarian Cysts	848
Fibrocystic Breast Disease	849
Malignant Tumors	849
Cervical Cancer	849
Endometrial Cancer	852
Ovarian Cancer	852
Breast Cancer	853
Positional Disorders of the Pelvic Region	856
Pregnancy	856
Anatomy and Physiology	856
First Trimester	857
Second Trimester	857
Third Trimester	857
Parturition	857
Pregnancy Complications	858
Infertility and Abortions	858
Placental Abnormalities	859
Maternal Disorders	859
Gestational Diabetes.	859
Hypertension.	860
Menopause	860
The Medical Assistant’s Role in Gynecologic and Obstetric Procedures	860
Examination Preparation	861
Assisting with the Examination	861
Breast Examination	862
Abdominal Examination	862
Pelvic Examination	863
Postexamination Duties	863
Diagnostic Testing	863
Sonography	863
Mammography	864
Pregnancy Testing	865
Closing Comments	865
Patient Education	865
Legal and Ethical Issues	866
Connections	868
Study Guide Connection:	868
Evolve Connection:	868
42 Assisting in Pediatrics	869
Learning Objectives	869
Vocabulary	870
Scenario	869
Normal Growth and Development	870
Growth Patterns	870
Denver II Developmental Screening Test	872
Developmental Patterns	872
Developmental Theories	872
Pediatric Diseases and Disorders	875
Gastrointestinal Disorders	875
Colic	875
Diarrhea	875
Failure to Thrive	876
Obesity	877
Respiratory Disorders	877
Common Cold	877
Otitis Media	877
Croup	878
Bronchiolitis	878
Asthma	878
Influenza	879
Infectious Diseases	879
Conjunctivitis	879
Tonsillitis	879
Fifth Disease	879
Hand-Foot-and-Mouth Disease	880
Varicella (Chickenpox)	880
Meningitis	880
Hepatitis B	880
Reye’s Syndrome	881
Inherited Disorders	881
Cystic Fibrosis	881
Duchenne’s Muscular Dystrophy	882
Immunizations	882
The Pediatric Patient	885
Well-Child Visits	885
Sick-Child Visits	887
The Medical Assistant’s Role in Pediatric Procedures	888
Measurement	889
Assisting with the Examination	893
Obtaining a Urine Sample	894
Injury Prevention	895
The Adolescent Patient	895
Child Abuse	895
Closing Comments	897
Patient Education	897
Legal and Ethical Issues	898
Connections	900
Study Guide Connection:	900
Evolve Connection:	900
43 Assisting in Orthopedic Medicine	901
Learning Objectives	901
Vocabulary	902
Scenario	901
Anatomy and Physiology of the Musculoskeletal System	902
Muscles	902
Bones	902
Joints	906
Types of Joints	906
Ligaments, Tendons, and Bursae	907
Musculoskeletal Diseases and Disorders	907
Muscular Disorders	909
Fibromyalgia	909
Myasthenia Gravis	910
Sprains, Strains, and Spasms	910
Skeletal Disorders	911
Fractures	911
Osteomalacia	912
Osteoporosis	913
Spinal Column Disorders	913
Abnormal Spinal Curvatures	913
Herniated Disk	913
Joint Disorders	914
Dislocation	914
Gout	915
Lupus	916
Infectious Arthritis	916
Lyme Disease	916
Osteoarthritis	917
Rheumatoid Arthritis	917
Tendonitis and Bursitis	917
The Medical Assistant’s Role in Assisting with Orthopedic Procedures	918
Assisting with the Examination	918
Specialized Diagnostic Procedures in Orthopedics	918
Range-of-Motion Evaluation	918
Muscle Strength Evaluation	919
Radiology	919
Therapeutic Modalities	919
General Principles of Cold Application	920
Heat Modalities	920
Paraffin Bath	921
Hot Water Bottle	921
Therapeutic Ultrasonography	921
Massage and Exercise	922
Electrical Muscle Stimulation	922
Ambulatory Devices	924
Crutches	924
Walkers	926
Canes	926
Wheelchairs	927
Assisting with Casting	927
Closing Comments	931
Patient Education	931
Legal and Ethical Issues	931
Connections	933
Study Guide Connection:	933
Evolve Connection:	933
44 Assisting in Neurology and Mental Health	934
Learning Objectives	934
Vocabulary	935
Scenario	934
Anatomy and Physiology of the Nervous System	935
Central Nervous System	936
Brain	936
Spinal Cord	937
Meninges	937
Peripheral Nervous System	938
Diseases and Disorders of the Central Nervous System	938
Cerebrovascular Disease	938
Transient Ischemic Attacks	938
Cerebrovascular Accident	939
Migraine Headache	941
Dementia and Alzheimer’s Disease	942
Epilepsy and Seizure Disorders	942
Central Nervous System Infections	944
Encephalitis	944
Meningitis	944
Brain and Spinal Cord Injuries	944
Cerebral Concussion and Contusion	944
Open and Closed Head Injuries	945
Shaken Baby Syndrome	945
Spinal Cord Injuries	946
Additional Central Nervous System Pathologies	946
Parkinson’s Disease	946
Tumors	946
Diseases of the Peripheral Nervous System	947
Multiple Sclerosis	947
Amyotrophic Lateral Sclerosis	947
Bell’s Palsy	947
Peripheral Neuropathy	947
Carpal Tunnel Syndrome	947
Mental Health	948
Depressive Disorders	948
Anxiety Disorders	948
Schizophrenia	949
The Medical Assistant’s Role in the Neurologic Examination	949
Diagnostic Testing	949
Electroencephalography	949
Lumbar Puncture	950
Closing Comments	950
Patient Education	950
Legal and Ethical Issues	954
HIPAA Applications	954
Connections	956
Study Guide Connection:	956
Evolve Connection:	956
45 Assisting in Endocrinology	957
Learning Objectives	957
Vocabulary	958
Scenario	957
Anatomy and Physiology of the Endocrine System	958
Basic Anatomy	958
Mechanisms of Hormone Action	960
Diseases and Disorders of the Endocrine System	960
Posterior Pituitary Gland Disorder	960
Diabetes Insipidus	960
Diseases of the Anterior Pituitary	960
Growth Hormone Abnormalities	960
Disorders of the Thyroid	961
Hypothyroidism	961
Hyperthyroidism	962
Disorders of the Adrenal Glands	962
Endocrine Dysfunction of the Pancreas: Diabetes Mellitus	963
Prediabetes	963
Type 1 Diabetes	963
Type 2 Diabetes	966
Gestational Diabetes	967
Complications of Diabetes Mellitus	968
Acute Complications.	968
Chronic Complications	969
Microvascular Disease.	969
Macrovascular Disease.	969
Diabetic Neuropathy.	969
Infection.	970
Follow-Up for Patients with Diabetes	970
Developing a Diabetic Patient Education Plan	970
Closing Comments	971
Patient Education	971
Legal and Ethical Issues	971
Connections	973
Study Guide Connection:	973
Evolve Connection:	973
46 Assisting in Pulmonary Medicine	974
Learning Objectives	974
Vocabulary	975
Scenario	974
The Respiratory System	975
Upper Respiratory Tract	975
Lower Respiratory Tract	975
Ventilation	977
Inspiration	978
Expiration	978
Respiratory System Defenses	978
Major Diseases of the Respiratory System	979
Infectious Diseases	979
Upper Respiratory Tract Infections	979
Common Cold.	979
Sinusitis.	979
Allergic Rhinitis (Hay Fever).	980
Lower Respiratory Tract Infections	980
Pneumonia.	980
Tuberculosis.	980
Chronic Obstructive Pulmonary Disease	982
Asthma	982
Pneumoconioses	984
Emphysema	984
Obstructive Sleep Apnea	986
Cancer of the Pulmonary System	987
Lung Cancer	987
Carcinoma of the Larynx	988
The Medical Assistant’s Role in Pulmonary Procedures	988
Assisting with the Examination	988
Diagnostic Procedures	988
Tuberculosis	988
Spirometry	988
Test Results.	990
Pulse Oximetry	990
Obtaining Sputum for Culture	991
Methods of Collection.	991
Bronchoscopy	992
Closing Comments	992
Patient Education	992
Legal and Ethical Issues	992
Connections	994
Study Guide Connection:	994
Evolve Connection:	994
47 Assisting in Cardiology	995
Learning Objectives	995
Vocabulary	996
Scenario	995
Anatomy and Physiology of the Heart	996
Layers of the Heart	996
Heart Chambers and Arteries	997
Heart Conduction	997
Diseases and Disorders of the Heart	998
Coronary Artery Disease and Myocardial Infarction	999
Diagnostic and Therapeutic Procedures	1000
Hypertensive Heart Disease	1001
Congestive Heart Failure	1002
Orthostatic Hypotension	1003
Inflammations and Valvular Disorders	1003
Rheumatic Heart Disease	1003
Valvular Disorders	1003
Blood Vessels	1004
Arteries	1004
Veins	1004
Vascular Disorders	1004
Shock	1004
Vein Disorders	1004
Varicose Veins	1004
Deep Vein Thrombosis	1004
Arterial Disorders	1007
Arteriosclerosis and Atherosclerosis	1007
Aneurysm	1007
Peripheral Arterial Disease	1007
Diagnostic Procedures and Treatments	1007
Doppler Studies	1008
Angiography	1008
Echocardiography	1008
Cardiac Catheterization and Angioplasty	1009
Cardiac Pacemakers	1009
Implantable Cardioverter-Defibrillator	1010
Closing Comments	1010
Patient Education	1010
Legal and Ethical Issues	1010
Connections	1012
Study Guide Connection:	1012
Evolve Connection:	1012
48 Assisting in Geriatrics	1013
Learning Objectives	1013
Vocabulary	1014
Scenario	1013
Changes in Anatomy and Physiology	1014
Cardiovascular System	1016
Endocrine System	1017
Gastrointestinal System	1017
Integumentary System	1017
Musculoskeletal System	1018
Osteoporosis	1019
Falls	1019
Nervous System	1019
Alzheimer’s Disease	1020
Pulmonary System	1022
Sensory Organs	1022
Vision	1022
Cataracts, Glaucoma, and Macular Degeneration.	1023
Hearing	1023
Taste and Smell	1024
Nutritional Status.	1024
Urinary System	1024
Reproductive System	1025
Sleep Disorders	1025
Living Arrangements	1026
The Medical Assistant’s Role in Caring for the Older Patient	1026
Closing Comments	1027
Patient Education	1027
Legal and Ethical Issues	1027
Connections	1029
Study Guide Connection:	1029
Evolve Connection:	1029
Unit Nine Diagnostic Procedures	1030
49 Principles of Electrocardiography	1030
Learning Objectives	1030
Vocabulary	1031
Scenario	1030
The Electrical Conduction System of the Heart	1032
The Cardiac Cycle	1032
Polarization, Depolarization, and Repolarization	1032
PQRST Complex	1032
The Electrocardiograph	1034
Electrocardiograph Paper	1034
Electrodes and Leads	1035
Lead Recordings	1035
Standard Leads	1035
Augmented Leads	1035
Precordial Leads	1036
Performing Electrocardiography	1036
Preparation of the Room and Patient	1036
Attaching Leads to the Patient	1036
Recording the Electrocardiogram	1037
Standardization, Sensitivity, and Speed	1037
The ECG Tracing and the Medical Record	1040
Telephone Transmission	1040
Interpretive Electrocardiographs	1040
Artifacts	1041
Wandering Baseline	1041
Somatic Tremor	1041
Alternating Current (AC) Interference	1041
Interrupted Baseline	1041
Interpreting an ECG Strip	1042
Normal Appearance of ECG Complexes	1042
Rate	1042
Rhythm	1043
Typical ECG Rhythm Abnormalities	1043
Sinus Arrhythmias	1043
Atrial Arrhythmias	1043
Ventricular Arrhythmias	1043
Biochemical Arrhythmias	1044
Pacemaker Rhythms	1045
Implanted Cardioverter-Defibrillator	1045
Myocardial Infarction	1045
Related Cardiac Diagnostic Tests	1047
Stress Test	1047
Holter Monitor	1048
Cardiac Event Monitor	1051
Heart Scan	1051
Closing Comments	1051
Patient Education	1051
Legal and Ethical Issues	1051
Connections	1053
Study Guide Connection:	1053
Evolve Connection:	1053
50 Assisting with Diagnostic Imaging	1054
Learning Objectives	1054
Vocabulary	1055
Scenario	1054
Basic Principles of Radiography	1056
Radiography	1056
X-Ray Exposure	1056
Prime Factors	1056
Technique Charts	1057
Radiographic Equipment	1057
X-Ray Tube and Housing	1057
X-Ray Tube Support	1057
Radiographic Table	1057
Grids and Bucky Devices	1057
Upright Cassette Holder	1058
Control Console	1058
Image Receptor Systems	1058
Cassettes and Intensifying Screens	1058
Film	1059
Film Care and Handling.	1059
Film Processing.	1059
Daylight Processing.	1060
Computed and Digital Radiography	1060
Radiographic Positioning	1060
Projections	1061
Diagnostic Imaging Modalities	1061
Fluoroscopy and Contrast Media	1061
Fluoroscopy	1061
X-Ray Studies Using Contrast Media	1062
Cardiovascular and Interventional Radiography	1064
Computed Tomography	1064
Magnetic Resonance Imaging	1065
Sonography	1066
Nuclear Medicine	1067
DEXA Scan	1068
Basic Radiographic Procedure	1068
Patient Preparation and Explanation	1068
Scheduling and Sequencing Diagnostic Imaging Procedures	1070
Radiation Safety	1071
Radiation Units	1071
Effects of Low-Dose Radiation Exposure	1073
Cellular Response to Exposure	1073
Somatic Effects	1073
Radiation and Pregnancy	1073
Genetic Effects	1074
Radiation Protection	1074
Personnel Safety	1074
Personnel Monitoring	1075
Effective Dose Equivalent Limits	1075
Occupational Precautions During Pregnancy	1076
Patient Protection	1076
Gonad Shielding	1076
Pregnant or Possibly Pregnant Patients	1076
The Role of the Medical Assistant	1077
Closing Comments	1078
Legal and Ethical Issues	1078
Connections	1080
Study Guide Connection:	1080
Evolve Connection:	1080
51 Assisting in the Clinical Laboratory	1081
Learning Objectives	1081
Vocabulary	1082
Scenario	1081
Role of the Clinical Laboratory in Patient Care	1082
Personnel in the Clinical Laboratory	1082
Clinical Laboratory Testing	1082
Clinical Laboratory Improvement Amendments	1083
Waived Tests	1083
Moderate- and High-Complexity Tests	1085
Divisions of the Clinical Laboratory	1085
Urinalysis	1085
Hematology	1085
Chemistry	1085
Microbiology	1085
Laboratory Safety	1085
Safety Standards and Governing Agencies	1085
Laboratory Hazards	1086
Physical Hazards	1086
Chemical Hazards	1086
Biologic Hazards and Infection Control	1092
Standard Precautions	1092
Specimen Collection, Processing, and Storage	1093
Laboratory Requisitions and Reports	1093
Specimen Collection	1093
Preventing Contamination	1094
Proper Handling, Processing, and Storage	1095
Chain of Custody	1095
Quality Assurance and Quality Control	1095
Quality Assurance Guidelines	1095
Quality Control Guidelines	1096
Laboratory Mathematics and Measurement	1096
Measuring Time	1096
Measuring Temperature	1097
Units of Measurement	1097
Measuring Liquid Volume	1097
Preparing Dilutions	1099
Clinical Laboratory Equipment	1099
Microscope	1099
Centrifuge	1101
Incubator	1102
Autoclave	1102
Closing Comments	1102
Patient Education	1102
Legal and Ethical Issues	1103
Connections	1104
Study Guide Connection:	1104
Evolve Connection:	1104
52 Assisting in the Analysis of Urine	1105
Learning Objectives	1105
Vocabulary	1106
Scenario	1105
Physiology of Urine Formation	1106
Anatomy of the Urinary Tract	1106
Formation of Urine	1107
Collecting a Urine Specimen	1107
Patient Sensitivity	1107
Containers	1107
Methods of Specimen Collection	1108
Handling and Transportation of a Specimen	1109
Routine Urinalysis	1112
Physical Examination of the Urine	1112
Appearance	1112
Color.	1112
Turbidity.	1112
Volume	1112
Foam	1113
Odor	1113
Specific Gravity	1114
Chemical Examination of Urine	1114
pH	1118
Glucose	1118
Protein	1118
Ketones	1118
Blood	1118
Bilirubin and Urobilinogen	1118
Nitrite	1119
Leukocyte Esterase	1119
Limitations of Reagent Strip Testing	1119
Microscopic Examination of Urine Sediment	1119
Casts	1122
Cells	1123
Crystals	1124
Miscellaneous Findings	1124
Interpretation of the Microscopic Examination	1127
Quality Assurance and Quality Control in Urinalysis	1127
Additional Tests Performed on Urine	1130
Clinitest	1130
Acetest	1130
Urine Pregnancy Testing	1130
Ovulation Testing	1132
Menopause Testing	1132
Bladder Tumor–Associated Antigen Testing	1132
Urine Toxicology	1134
Alcohol Testing	1137
Culturing the Urine	1137
Closing Comments	1137
Patient Education	1137
Legal and Ethical Issues	1139
Connections	1140
Study Guide Connection:	1140
Evolve Connection:	1140
53 Assisting in Phlebotomy	1141
Learning Objectives	1141
Vocabulary	1142
Scenario	1141
Venipuncture Equipment	1142
Gloves	1143
Tourniquets	1143
Antiseptics	1143
Evacuated Collection Tubes	1144
Tube Additives	1144
Order of Collection	1146
Types of Sharps and Supplies Used in Phlebotomy	1146
Multisample Needles	1146
Syringes	1147
Winged Infusion Sets (Butterfly Needles)	1147
Needle Holders	1147
Needle Safety	1147
Postexposure Management of Needlesticks	1149
Routine Venipuncture	1150
Patient Preparation	1150
Preparing for the Venipuncture	1150
Performing the Venipuncture	1151
Completing the Venipuncture	1151
Problems Associated with Venipuncture	1151
Specimen Re-collection	1160
Capillary Puncture	1161
Equipment	1162
Skin Puncture Devices	1162
Collection Containers	1162
Routine Capillary Puncture	1163
Site Selection	1163
Patient Preparation	1164
Collecting the Specimen	1164
Specimen Handling	1164
Pediatric Phlebotomy	1164
Postcollection Specimen Handling	1168
Chain of Custody	1168
Closing Comments	1168
Patient Education	1168
Legal and Ethical Issues	1169
Connections	1171
Study Guide Connection:	1171
Evolve Connection:	1171
54 Assisting in the Analysis of Blood	1172
Learning Objectives	1172
Vocabulary	1173
Scenario	1172
Hematology	1173
Erythrocytes	1173
Leukocytes	1174
T Cells	1174
B Cells	1174
Thrombocytes	1174
Clot Formation	1174
Plasma	1175
Collection of Blood Specimens	1175
Hematocrit	1175
Hemoglobin	1178
Red Blood Cell Count	1180
White Blood Cell Count	1180
Determining the Red Blood Cell and White Blood Cell Counts	1180
Red Cell Indices	1182
Differential Cell Count	1183
Preparation of Blood Smears for the Differential	1183
Staining of Blood Smears	1183
Identification of Normal Blood Cells	1183
Differential Examination	1185
Red Blood Cell Morphology	1185
Size	1185
Shape	1185
Content	1186
Platelet Analysis	1186
Erythrocyte Sedimentation Rate	1186
Coagulation Testing	1188
Immunohematology	1188
Blood Grouping	1189
Determination of ABO Blood Group	1189
Determination of Rh Factor	1189
Other Blood Types	1192
Rare Blood Types	1192
Clinical Chemistry	1192
Blood Glucose Testing	1192
Hemoglobin A1c Testing	1193
Cholesterol Testing	1194
Thyroid Hormone Testing	1194
Alanine Aminotransferase and Aspartate Aminotransferase Testing	1194
Chemistry Panels	1196
Closing Comments	1196
Legal and Ethical Issues	1196
Connections	1202
Study Guide Connection:	1202
Evolve Connection:	1202
55 Assisting in Microbiology and Immunology	1203
Learning Objectives	1203
Vocabulary	1204
Scenario	1203
Specimen Collection and Transport	1204
Classification of Microorganisms	1207
Naming of Microorganisms	1208
Typical Pathogenic Bacteria	1209
Bacterial Shapes	1209
Bacterial Oxygen Requirements	1209
Bacterial Physical Structures	1210
Unusual Pathogenic Bacteria: Chlamydiae, Mycoplasmas, and Rickettsiae	1211
Fungi	1212
Parasites	1213
Helminths	1213
Protozoa	1213
Microbiology Laboratory	1215
Inoculating Equipment	1215
Incineration Equipment	1216
Culture Media	1216
Inoculation of Media	1217
Identification of Pathogens in the Microbiology Laboratory	1217
Assessing a Culture	1217
Throat Culture	1217
Urine Cultures	1218
Staining	1220
Gram Stain	1221
Acid-Fast Stain	1223
Biochemical Testing	1224
Rapid Identification Methods	1224
Rapid Strep Testing	1224
Influenza a and B Testing	1224
Respiratory Syncytial Virus Testing	1224
Antimicrobial Susceptibility Testing	1224
Miscellaneous Microbiologic Testing	1225
Testing for Pinworms	1225
Immunologic Testing	1226
Infectious Mononucleosis Testing	1226
Helicobacter Pylori Antibody Testing	1228
Human Immunodeficiency Virus Antibody Testing	1228
Lyme Disease Antibody Testing	1228
Closing Comments	1229
Patient Education	1229
Legal and Ethical Issues	1230
Nationally Notifiable Infectious Conditions	1230
Nationally Notifiable Noninfectious Conditions	1231
Connections	1232
Study Guide Connection:	1232
Evolve Connection:	1232
Unit Ten Assisting with Surgeries	1233
56 Surgical Supplies and Instruments	1233
Learning Objectives	1233
Vocabulary	1234
Scenario	1233
Minor Surgery Room	1234
Surgical Solutions and Medications	1234
Surgical Instruments	1236
Classifications of Surgical Instruments	1237
Cutting and Dissecting Instruments	1237
Bandage Scissors (Figure 56-6, A)	1237
Operating (Surgical) Scissors	1237
Metzenbaum (Metz) Scissors (Figure 56-6, B)	1237
Mayo Scissors (Figure 56-6, C and D)	1237
Iris Scissors (Figure 56-6, E and F)	1237
Littauer Stitch or Suture Scissors (Figure 56-7)	1237
Disposable Scalpels (Figure 56-8)	1237
Grasping and Clamping Instruments	1238
Hemostat Forceps (Figure 56-9, A and B)	1238
Needle Holders (Figure 56-9, C and D)	1238
Splinter Forceps	1239
Adson Forceps (Figure 56-10)	1239
Plain Thumb (Dressing) Forceps (Figure 56-11)	1239
Towel Forceps (Towel Clamp) (Figure 56-12)	1239
Allis Tissue Forceps (Figure 56-13, A)	1239
Foerster Sponge Forceps (Figure 56-13, B)	1239
Transfer Forceps (Figure 56-13, C to E)	1240
Adson Thumb Forceps (Figure 56-14, A and B)	1240
Bayonet Forceps (Figure 56-14, C to E)	1240
Plain-Tip Tissue Forceps (Figure 56-14, F)	1240
Toothed Tissue Forceps (Figure 56-14, G)	1241
Retractors	1241
Senn Retractor (Figure 56-15)	1241
Probes and Dilators	1241
Probes (Figure 56-16, A to C)	1241
Trocars and Obturators (Figure 56-16, D to G)	1241
Specula (Figure 56-17)	1241
Nasal Specula (see Figure 56-17, A and B)	1242
Specialty Instruments	1242
Gynecologic Instruments	1242
Foerster Sponge Forceps (Figure 56-18, A)	1242
Placenta Forceps (Figure 56-18, B)	1243
Bozeman Uterine Dressing Forceps (Figure 56-18, C)	1243
Endocervical Curette (Figure 56-18, D)	1243
Sims Uterine Curette (Figure 56-18, E)	1243
Schroeder Uterine Vulsellum Forceps (Figure 56-18, F)	1243
Long Allis Forceps (Figure 56-18, G)	1243
Schroeder Uterine Tenaculum Forceps (Figure 56-18, H)	1243
Hegar Uterine Dilators (Figure 56-19, A)	1243
Sims Uterine Sounds (Figure 56-19, B)	1243
Ophthalmologic and Otolaryngologic Instruments	1243
Krause Nasal Snare (Figure 56-20, A)	1243
Metal Tongue Depressor (Figure 56-20, B)	1243
Hartmann “Alligator” Ear Forceps (Figure 56-20, C)	1243
Laryngeal Mirror (Figure 56-20, D)	1244
Ivan Laryngeal Metal Applicator (Figure 56-20, E)	1244
“Buck” Ear Curette (Figure 56-20, F)	1244
Sharp Ear Dissector (Figure 56-20, G)	1244
Biopsy Instruments	1244
Cervical Biopsy Forceps (Figure 56-21, A)	1244
Rectal Biopsy Punch (Figure 56-21, B)	1244
Silverman Biopsy Needle	1244
Genitourinary Instruments	1244
Catheter Guide (Figure 56-22, A)	1244
Foley Catheter with Inflated Balloon (Figure 56-22, B)	1244
Red Robinson Catheter (Figure 56-22, C)	1245
12-mL Luer-Lok Syringe (Figure 56-22, D)	1245
Care and Handling of Instruments	1245
Drapes, Sutures, and Needles	1246
Sutures	1246
Absorbable Sutures	1246
Nonabsorbable Sutures	1247
Suture Sizing and Packaging	1247
Needles	1248
Closing Comments	1248
Patient Education	1248
Legal and Ethical Issues	1248
Connections	1249
Study Guide Connection:	1249
Evolve Connection:	1249
57 Surgical Asepsis and Assisting with Surgical Procedures	1250
Learning Objectives	1250
Vocabulary	1251
Scenario	1250
Sterilization	1251
Autoclave	1252
Wrapping Materials	1253
Wrapping Instruments	1253
Sterilization Indicators	1256
Chemical Sterilization Indicators.	1256
Biologic Sterilization Indicators.	1256
Quality Assurance Records for Office Sterilization	1256
Loading the Autoclave	1256
Unloading Guidelines	1257
Shelf Life of Sterilized Packs.	1257
Gas Sterilization	1258
Chemical Sterilization	1258
Surgical Procedures	1258
Electrosurgery	1258
Laser Surgery	1258
Microsurgery	1259
Endoscopic Procedures	1259
Cryosurgery	1259
Assisting with Surgical Procedures	1259
Preparation of the Patient	1259
Preoperative Instructions	1260
Informed Consent	1260
Positioning	1260
Skin Preparation	1260
Preparation of the Room	1260
Sterile Technique	1262
Sterile Field	1262
Assisting the Physician during Surgery	1270
Passing Instruments	1270
Specimen Collection	1275
Completing the Surgical Procedure	1275
Postoperative Responsibilities	1277
Postoperative Instructions and Care	1278
Warning Signs	1278
Follow-Up	1278
Wound Care	1281
Wound Healing	1281
Dressings	1282
Bandages	1283
Closing Comments	1285
Patient Education	1285
Legal and Ethical Issues	1285
Connections	1289
Study Guide Connection:	1289
Evolve Connection:	1289
Unit Eleven Career Development	1290
58 Career Development and Life Skills	1290
Learning Objectives	1290
Vocabulary	1291
Scenario	1290
What Does the Employer Want?	1291
Assessing Strengths	1292
Developing Career Objectives	1292
Knowing Personal Needs	1292
Finding a Job	1292
Two Best Job Search Methods	1293
Internet and the Job Search	1294
Traditional Job Search Methods	1294
School Career Placement Offices	1294
Newspaper Ads	1294
Employment Agencies	1294
Professional Organizations	1294
Volunteering	1294
Mailing Resumés	1294
Cold Calling	1295
Performing Well on Externships	1295
Organizing the Job Search	1295
Developing a Resumé	1295
Critical Resumé Errors	1296
Argument about Length	1300
Purpose of a Resumé	1300
Cover Letter	1301
Job Applications	1302
Job Interview	1305
Preparation for the Interview	1305
Interview	1307
Follow-Up after the Interview	1308
Negotiation	1309
You Got the Job!	1309
Common Early Mistakes	1309
Being a Good Employee	1309
Dealing with Supervisors	1310
Performance Appraisals	1310
Asking for a Raise	1311
Leaving a Job	1311
Life Skills	1311
Personal Growth	1311
Self-Control	1311
Self-Esteem	1311
Problem-Solving Skills	1312
Decision-Making Skills	1312
Stress Management	1312
Planning a Budget	1312
Student Loans	1312
Guideline Budget	1313
Getting a Paycheck	1313
Dangerous Habits	1313
Closing Comments	1314
Patient Education	1314
Legal and Ethical Issues	1314
Connections	1316
Study Guide Connection:	1316
Evolve Connection:	1316
ICD-10 Diagnostic Coding	e1
Learning Objectives	e1
Vocabulary	e1
Scenario	e1
Introduction to the International Classification of Diseases Coding System	e2
Two Major Coding Structures	e2
History and Development of the ICD Coding System	e2
Uses of Coded Data	e2
Why the Change to ICD-10-CM?	e2
ICD-10-CM Coding and Reporting Guidelines	e3
Process of Classifying Diseases	e3
ICD-10-CM Code Structure	e5
Format of the ICD-10-CM Manual	e5
Alphabetic Index	e6
Main Terms.	e6
Essential and Nonessential Modifiers.	e8
Conventions Used in Alphabetic Index	e9
Parentheses.	e9
Cross-References (See and See also).	e9
Example	e9
Glossary	1317
Index	1340
A	1340
B	1342
C	1343
D	1345
E	1347
F	1349
G	1349
H	1350
I	1352
J	1353
K	1353
L	1353
M	1354
N	1356
O	1357
P	1358
Q	1361
R	1361
S	1362
T	1364
U	1365
V	1365
W	1366
X	1366
Y	1366
Z	1366

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