Kinn's The Medical Assistant

Deborah B. Proctor; Brigitte Niedzwiecki; Julie Pepper; Payel Madero; Marti Garrels; Helen Mills

BOOK

Kinn's The Medical Assistant

(2016)

Additional Information

Book Details

ISBN: 978-0-323-44418-7
Edition: 13
Language: English
Pages: 1312
Subjects: Medical profession
Dentistry

Abstract

Comprehensive Medical Assisting begins with Kinn! Elsevier’s 60^th Anniversary edition of Kinn’s The Medical Assistant, 13^th Edition provides you with real-world administrative and clinical skills that are essential to working in the modern medical office. An applied learning approach to the MA curriculum is threaded throughout each chapter to help you further develop the tactile and critical thinking skills necessary for working in today’s healthcare setting. Paired with our adaptive solutions, real –world simulations, EHR documentation and HESI remediation and assessment, you will learn the leading skills of modern administrative and clinical medical assisting in the classroom!

Basics of Diagnostic Coding prepares you to use the ICD-10 coding system.
Learning objectives listed in the same order as content makes it easy to review material.
Clinical procedures integrated into the TOC give you a quick reference point.
Professional behavior boxes provide guidelines on how to interact with patients, families, and coworkers.
Patient education and legal and ethical issues are described in relation to the Medical Assistant's job.
Applied approach to learning helps you use what you’ve learned in the clinical setting.
Learning objectives and vocabulary with definitions highlight what’s important in each chapter.
Critical thinking applications test your understanding of the content.
Step-by-step procedures explain complex conditions and abstract concepts.
Rationales for each procedure clarify the need for each step and explains why it’s being performed.
Portfolio builder helps you demonstrate your mastery of the material to potential employers.

NEW! Chapter on The Health Record reviews how you’ll be working with a patient’s medical record.
NEW! Chapter on Technology in the Medical Office introduces you to the role EHR technology plays in the medical office.
NEW! Chapter on Competency-Based Education helps you understand how your mastery of the material will affect your ability to get a job.
NEW! Clinical procedure videos helps you visualize and review key procedures.

Section Title	Page	Action	Price
Front Cover	cover
Inside Front Cover	ifc1
Procedures	IFC3
Kinn's The Medical Assistant	i
Copyright Page	iv
Preface	v
New to This Edition	v
Evolve	v
Study Guide and Procedure Checklist Manual	v
Features	v
Reviewers	xi
Table Of Contents	xiii
Unit One Introduction to Medical Assisting	1
1 Competency-Based Education and the Medical Assistant Student	1
Learning Objectives	1
Vocabulary	1
Scenario	1
Adult Learners and Competency-Based Education	2
Portfolios	2
Who You are as a Learner: How Do You Learn Best?	3
Learning Style Inventory	3
Using Your Learning Profile to Be a Successful Student: Where Do I Go From Here?	4
Coping Mechanisms	5
Time Management: Putting Time on Your Side	6
How to Put Time on Your Side	6
Study Skills: Tricks for Becoming a Successful Student	7
Test-Taking Strategies: Taking Charge of Your Success	9
Becoming a Critical Thinker: Making Mental Connections	10
Tables and Graphs	10
Problem Solving and Conflict Management	11
Assertive, Aggressive, and Passive Communication	12
Assertive Communication	12
Passive and Aggressive Behaviors and Language	12
Summary of Scenario	13
Summary of Learning Objectives	13
Connections	14
2 The Medical Assistant and the Healthcare Team	15
Learning Objectives	15
Vocabulary	15
Scenario	15
The History of Medicine	16
National Departments and Agencies That Focus on Health	18
Professional Medical Assisting Organizations	18
Medical Assistant Job Description	18
Allied Health Professionals	19
Medical Professionals	20
Doctors of Medicine	20
Doctors of Osteopathy	20
Doctors of Chiropractic	20
Hospitalists	20
Dentists	25
Optometrists	25
Podiatrists	25
Nurse Practitioners	26
Nurse Anesthetists	26
Physician Assistants	26
Types of Healthcare Facilities	26
Hospitals	26
Primary Level of Care	26
Secondary Level of Care	26
Tertiary Level of Care	26
Ambulatory Care	27
Other Healthcare Facilities	27
The Patient-Centered Medical Home	27
Scope of Practice and Standards of Care for Medical Assistants	28
Closing Comments	29
Patient Education	29
Legal and Ethical Issues	30
Summary of Scenario	30
Summary of Learning Objectives	30
Connections	31
3 Professional Behavior in the Workplace	32
Learning Objectives	32
Vocabulary	32
Scenario	32
The Meaning of Professionalism	32
Work Ethics	33
Attributes of Professional Medical Assistants	33
Courteous and Respectful	33
Diplomatic and Tactful	34
Responsible and Honest	34
Response to Criticism	34
Professional Image	34
Obstructions to Professionalism	35
Personal Problems and “Baggage”	35
Rumors and the “Grapevine”	35
Personal Phone Calls and Business	35
Establishing Healthy Self-Boundaries	36
The Healthcare Team	36
Time Management	36
Prioritizing	37
Medical Assistant Organizations	37
Closing Comments	38
Patient Education	38
Legal and Ethical Issues	38
Summary of Scenario	38
Summary of Learning Objectives	38
Connections	39
4 Therapeutic Communication	40
Learning Objectives	40
Vocabulary	40
Scenario	40
First Impressions	41
Patient-Centered Care	41
Communication Paths	41
Verbal Communication	41
Nonverbal Communication	42
Recognizing and Responding to Verbal and Nonverbal Communications	44
Communication Barriers	44
Providing Unwarranted Assurance	44
Giving Advice	44
Using Medical Terminology	45
Leading Questions	45
Talking Too Much	45
Stereotyping	45
Physical Impairment	45
Language	45
Sensitivity to Diversity	45
Overcoming Barriers to Communication	46
Communication during Difficult Times	46
Therapeutic Techniques	46
Active Listening Techniques	47
Open and Closed Questions or Statements	49
Communication Across the Life Span	49
Maslow’s Hierarchy of Needs	50
Closing Comments	50
Patient Education	50
Legal and Ethical Issues	51
Summary of Scenario	51
Summary of Learning Objectives	51
Connections	52
5 Medicine and Law	53
Learning Objectives	53
Vocabulary	53
Scenario	53
Jurisprudence and the Classifications of Law	55
Criminal Law	55
Misdemeanors	55
Felonies	55
Civil Law	55
Tort Law	56
Contract Law	56
Anatomy of a Medical Professional Liability Lawsuit	56
What Constitutes a Valid Contract?	56
Breach of Contract	57
Medical Professional Liability Lawsuit	57
Interrogatories	57
Depositions	57
Subpoenas	57
Inside the Courtroom	58
Burden of Proof	58
Outcome of the Case	58
Mediation and Arbitration	58
Medical Liability and Negligence	59
The Four Ds of Negligence	59
Types of Damages	60
Risk Management Practices	60
Liability, Malpractice, and Personal Injury Insurances	60
Consent	61
Giving Consent to Medical Procedures	61
Statute of Limitations	62
Confidentiality	62
Law and Medical Practice	63
Compliance Reporting	63
Laws Having a Significant Impact on Healthcare	63
Patient Self-Determination Act	63
Uniform Anatomical Gift Act	64
Patients’ Bill of Rights	64
Americans with Disabilities Act	66
Genetic Information Nondiscrimination Act	67
Health Insurance Portability and Accountability Act	67
Notice of Privacy Practices.	67
HITECH Act	71
Affordable Care Act of 2010	72
Closing Comments	72
Patient Education	72
Legal and Ethical Issues	72
Summary of Scenario	73
Summary of Learning Objectives	74
Connections	75
6 Medicine and Ethics	76
Learning Objectives	76
Vocabulary	76
Scenario	76
History of Ethics in Medicine	79
Making Ethical Decisions	80
Elements of Ethics	80
Types of Ethical Problems	80
The Ethical Decision-Making Process	81
The Council on Ethical and Judicial Affairs	81
Opinions on Social Policy Issues	81
Preventing, Identifying, and Treating Violence and Abuse	81
HIV Testing	82
Withholding or Withdrawing Life-Prolonging Treatment	82
Organ Donation	82
Allocation of Health Resources	82
Opinions on Confidentiality, Advertising, and Communications	82
Advertising and Publicity	83
Advertising.	83
Communication with the Media.	83
Opinions on Practice Matters	83
Fees and Charges	83
Fee Splitting and Contingent Fees	84
Waiver of Insurance Co-Payments	84
Professional Courtesy	84
Conflicts of Interest	84
Unethical Conduct by Members of the Health Professions	84
Closing Comments	85
Patient Education	85
Legal and Ethical Issues	85
Summary of Scenario	85
Summary of Learning Objectives	86
Connections	86
Unit Two Ambulatory Care Administration	87
7 Technology and Written Communication	87
Learning Objectives	87
Vocabulary	87
Scenario	87
Electronic Technology in the Ambulatory Care Center	88
Personal Computer Hardware	89
Input Devices	89
Output Devices	91
Internal Components	91
Secondary Storage Devices	92
Network and Internet Access Devices	93
Maintaining Computer Hardware	93
Computer Workstation Ergonomics	94
Software Used in the Ambulatory Care Center	94
Computer Network Security	95
Technology Advances in Healthcare	96
Fundamentals of Written Communication	97
Parts of Speech	97
Appropriate Use of Words	98
Capitalization, Numbers, and Punctuation	98
Written Correspondence	100
Parts of a Professional Letter	101
Sender’s Address	101
Date	101
Inside Address	101
Reference Line	101
Salutation	101
Subject Line	101
Body of the Letter	101
Closing	102
Signature Block	103
End Notations	103
Continuation Pages	103
Business Letter Formats	103
Full Block Letter Format	103
Modified Block Letter Format	104
Semi–Block Letter Format	104
Letter Templates	106
Preparing the Letter for Delivery	106
Memorandums	107
Professional E-Mails	109
Faxed Communication	110
Closing Comments	110
Patient Education	110
Legal and Ethical Issues	110
Summary of Scenario	111
Summary of Learning Objectives	111
Connections	112
8 Telephone Techniques	113
Learning Objectives	113
Vocabulary	114
Scenario	113
Telephone Equipment	114
Multiple-Line Telephone	114
Headset	114
Features	114
Speakerphone	115
Conference Calls	115
Caller ID	115
Voice Mail	115
Call Forwarding	115
Intercom	116
Call Hold	116
Speed Dialing	116
Cell Phones	116
Telephone Equipment Needs of a Healthcare Facility	116
Number and Placement of Telephones	116
Effective Use of the Telephone	116
Active Listening	116
Developing a Pleasing Telephone Personality	117
Managing Telephone Calls	118
Thinking Ahead	118
Confidentiality	118
Answering Promptly	118
Identifying the Facility	119
Identifying the Caller	119
Screening Incoming Calls	119
Screening Guidelines	120
Getting the Information the Provider Needs	120
Placing Callers on Hold	120
Transferring a Call	120
Taking a Message	120
Messages Taken on Paper	122
Messages Recorded Electronically	122
Taking Action on Telephone Messages	122
Retaining Records of Telephone Messages	122
Typical Incoming Calls	123
Requests for Directions	123
Inquiries About Bills	123
Inquiries About Fees	123
Questions About Participating Providers	123
Requests for Assistance With Insurance	123
Radiology and Laboratory Reports	123
Satisfactory Progress Reports from Patients	124
Routine Reports from Hospitals and Other Sources	124
Requests for Referrals	124
Office Administration Matters	124
Special Incoming Calls	124
Patients Refusing to Discuss Symptoms	124
Unsatisfactory Progress Reports	124
Requests for Test Results	124
Requests for Information from Third Parties	125
Complaints About Care or Fees	125
Calls from Staff Members’ Families or Friends	125
Handling Difficult Calls	125
Angry Callers	125
Aggressive Callers	125
Unauthorized Inquiry Calls	125
Sales Calls	125
Callers With Difficulty Communicating	126
Typical Outgoing Calls	126
Time Zones	126
Long Distance Calling	126
Using a Telephone Directory	126
Telephone Services	127
Answering Services	127
Automatic Call Routing	127
Closing Comments	127
Patient Education	127
Legal and Ethical Issues	128
Summary of Scenario	128
Summary of Learning Objectives	128
Connections	130
9 Scheduling Appointments and Patient Processing	131
Learning Objectives	131
Vocabulary	132
Scenario	131
Establishing the Appointment Schedule	133
Patient Needs	133
Provider Preferences and Habits	133
Creating the Appointment Matrix	133
Establishing Guidelines for Appointment Scheduling	133
Available Facilities	135
Methods of Scheduling Appointments	135
Computerized Scheduling	135
Appointment Book Scheduling	136
Self-Scheduling	136
Legality of the Appointment Scheduling System	136
Types of Appointment Scheduling	137
Time-Specified (Stream) Scheduling	137
Wave Scheduling	137
Modified Wave Scheduling	137
Double-Booking	137
Open Office Hours	137
Grouping Procedures	137
Advance Booking	137
Time Patterns	137
Telephone Scheduling	138
Scheduling Appointments for New Patients	138
Scheduling Appointments for Established Patients	141
In Person	141
By Telephone	143
Scheduling Other Types of Appointments	143
Inpatient Surgeries	143
Outpatient and Inpatient Procedure Appointments	143
Outside Visits	145
Providers	145
Pharmaceutical Representatives	145
Salespeople	145
Special Circumstances	146
Late Patients	146
Rescheduling Appointments	146
Emergency Situations	146
Provider Referrals	146
Patients Without Appointments	146
Failed Appointments	146
No-Show Policy	146
Increasing Appointment Show Rates	147
Automated Call Routing	147
Appointment Cards	147
Confirmation Calls	147
E-Mail Reminders	147
Mailed Reminders	147
Handling Cancellations and Delays	147
When the Patient Cancels	147
When the Provider Is Delayed	147
When the Provider Is Called to an Emergency	147
When the Provider Is Ill or Out of Town	148
Patient Processing	149
The Reception Area	149
Preparing for Patient Arrival	151
Preparing Health Records	151
Patient Check-in	151
Greeting the Patient	152
Patient Interaction	153
Registration Procedures	153
Obtaining a Patient’s History	154
Showing Consideration for Patients’ Time	154
Patients With Special Needs	155
Escorting and Instructing the Patient	155
Health Record Care	155
Challenging Situations	155
Talkative Patients	155
Children	156
Angry Patients in the Reception Area	156
Patient’s Relatives and Friends	156
The Friendly Farewell	156
Patient Checkout	156
Planning for the Next Day	156
Closing Comments	156
Patient Education	157
Legal and Ethical Issues	157
Summary of Scenario	157
Summary of Learning Objectives	158
Connections	160
10 Daily Operations in the Ambulatory Care Setting	161
Learning Objectives	161
Vocabulary	161
Scenario	161
Medical Office Environment	162
Opening the Healthcare Facility	162
Closing the Healthcare Facility	164
Daily and Monthly Duties	164
Security in the Healthcare Facility	165
Equipment and Supplies	165
Equipment	165
Equipment Inventory	165
Equipment Safety and Maintenance	166
Service Calls and Warranties	168
Purchasing Equipment	168
Supplies	169
Inventory Management	169
Inventory Control Systems	169
Taking Inventory	171
Price Consideration When Ordering Supplies	171
Ordering Supplies	171
Receiving the Order	172
Handling Mail	174
United States Postal Service	174
Domestic United States Postal Services	174
Insurance and Additional Services	175
Private Delivery Services	176
Incoming Mail	176
Body Mechanics	177
Closing Comments	178
Patient Education	178
Legal and Ethical Issues	178
Summary of Scenario	179
Summary of Learning Objectives	179
Connections	180
11 The Health Record	181
Learning Objectives	181
Vocabulary	182
Scenario	181
Types of Records	183
The Importance of Accurate Health Records	183
Contents of the Health Record	183
Subjective Information	183
Personal Demographics	183
Past Health, Family, and Social History	184
Past Health History.	185
Patient’s Family History.	185
Patient’s Social History.	185
Patient’s Chief Complaint	186
Objective Information	187
Vital Signs and Anthropometric Measurements	187
Findings and Laboratory and Radiology Reports	187
Diagnosis	187
Treatment Prescribed and Progress Notes	187
Condition at the Time of Termination of Treatment	187
The Medical Assistant’s Role	187
Ownership of the Health Record	188
Technologic Terms in Health Information	188
American Recovery and Reinvestment Act	189
The Health Information Technology for Economic and Clinical Health Act and Meaningful Use	189
Advantages and Disadvantages of the EHR	189
Capabilities of Electronic Health Record Systems	191
Nonverbal Communication with the Patient When Using the Electronic Health Record	193
Backup Systems for the Electronic Health Record	194
Transfer, Destruction, and Retention of Electronic Health Records	194
Retention and Destruction	195
Releasing Health Record Information	195
Health Information Exchanges	197
Creating an Efficient Paper Health Records Management System	197
Organization of the Health Record	197
Source-Oriented Medical Records	197
Problem-Oriented Medical Records	197
Documenting in an Electronic Health Record	197
Documenting in a Paper Health Record	197
Making Corrections and Alterations to Health Records	199
Dictation and Transcription	199
Voice Recognition Software	199
Transfer, Destruction, and Retention of Paper Health Records	199
Retention and Destruction	200
Long-Term Storage	200
Filing Equipment	201
Drawer Files	201
Horizontal Shelf Files	201
Rotary Circular Files	201
Compactable Files	201
Automated Files	201
Card Files	201
Filing Supplies	202
Divider Guides	202
Outguides	202
File Folders	202
Labels	202
Indexing Rules	203
Filing Methods	205
Alphabetic Filing	205
Numeric Filing	205
Subject Filing	206
Color-Coding	206
Alphabetic Color-Coding	206
Numeric Color-Coding	206
Other Color-Coding Applications	206
Organization of Files	206
Health-Related Correspondence	206
General Correspondence	206
Practice Management Files	207
Miscellaneous Files	207
Tickler or Follow-Up Files	207
Transitory or Temporary File	207
Closing Comments	207
Patient Education	207
Legal and Ethical Issues	207
Summary of Scenario	208
Summary of Learning Objectives	208
Connections	210
Unit Three Coding and Medical Billing Procedures	211
12 Basics of Diagnostic Coding	211
Learning Objectives	211
Vocabulary	211
Scenario	211
The History of Medical Coding	212
Medical Coding in the United States	212
Getting to Know the ICD-10-CM	212
What Is Diagnostic Coding?	212
Transitioning from ICD-9-CM to ICD-10-CM	213
General Equivalence Mappings	213
Structure and Format of the ICD-10-CM	214
The Alphabetic Index	214
Supplementary Sections of the Alphabetic Index	215
The Tabular List	216
Conventions Used in the Tabular List	217
Placeholder Character.	217
Example 12-1—Using the Dummy Placeholder for the 5th Character.	217
Example 12-2—Using the Dummy Placeholder in 7-Character Codes.	217
Codes with 7 Characters.	217
Punctuation.	217
Instructional Notations.	217
Cross Reference Notes.	218
Relational Terms.	218
Coding Guidelines	218
Preparing for Medical Coding	219
Extracting Diagnostic Statements	219
Encounter Form	219
History and Physical Exam	219
Treatment or Progress Notes	219
Discharge Summary	219
Operative Report	219
Radiology, Laboratory, and Pathology Reports	219
Steps in ICD-10-CM Coding	219
Using the Alphabetic Index	223
Using the Tabular List	224
Encoder Software	224
Understanding Coding Guidelines	224
Coding of Signs and Symptoms	224
Coding the Etiology and Manifestation	225
Multiple Coding	225
Sequela (Late Effects) Codes	225
Coding Complications of Care	225
Coding Infectious and Parasitic Diseases	226
Coding Organism-Caused Diseases	226
Human Immunodeficiency Virus (HIV) Infection and Acquired Immunodeficiency Syndrome (AIDS)	226
Selection and Sequencing of HIV Codes	226
(a) Patient Admitted for HIV-Related Condition.	226
(b) Patient with HIV Disease Admitted for Unrelated Condition.	226
(c) HIV Infection in Pregnancy, Childbirth, and the Puerperium.	226
(d) Encounters for Testing for HIV.	226
Coding Neoplasms	226
Terms Defining Malignant Neoplasm Sites	226
Definitions of Benign, Uncertain Behavior, and Unspecified Nature Neoplasms	227
Six Steps for Coding Neoplasms	227
Coding for Diabetes Mellitus	227
Diabetes Mellitus and the Use of Insulin	227
Gestational Diabetes	228
Coding for the Circulatory System	228
Myocardial Infarction	228
Hypertensive Disease	228
Coding for Chronic Kidney Disease	229
Coding for Atherosclerotic Cardiovascular Disease	229
Coding for Skin Ulcers	229
Coding for Complications of Pregnancy, Childbirth, and the Puerperium	229
7th Character for Fetus Identification	230
Outcome of Delivery and Liveborn Infant Codes	230
Newborn Coding	230
Coding for Injuries	230
Superficial Injuries	230
Primary Injury With Damage to Nerves and/or Blood Vessels	230
Coding for Traumatic Fractures	230
Coding for Burns and Corrosions	230
Coding for Drug Toxicity	231
Coding for External Causes of Morbidity	231
Place of Occurrence Guideline	231
Activity Codes	231
Coding for Health Status and Contact With Health Services	231
Maximizing Third-Party Reimbursement	231
Providers and Accurate Coding	232
Closing Comments	232
Patient Education	233
Legal and Ethical Issues	233
Summary of Scenario	233
Summary of Learning Objectives	233
Connections	235
13 Basics of Procedural Coding	236
Learning Objectives	236
Vocabulary	236
Scenario	236
Introduction to the CPT Manual	237
The Organization of the CPT Manual	237
Category I Codes	237
Category II Codes	237
Category III Codes	237
The Evolution of CPT Coding	238
The Alphabetic Index	238
The Tabular List	238
Evaluation and Management Section	239
Anesthesia Section	239
Surgery Section	239
Radiology Section	239
Pathology and Laboratory Section	239
Medicine Section	240
Unlisted Procedure or Service Code	241
CPT Coding Guidelines	241
Modifiers	241
CPT Conventions	241
Appendices	241
Medical Documentation for CPT Coding	242
Steps for Efficient CPT Procedural Coding	244
Abstracting	244
Using the Alphabetic Index	246
Searching the Alphabetic Index	247
Using See and See Also in the Alphabetic Index	247
Use of the Semicolon	247
Stand-Alone Codes and Code Ranges	247
Using the Tabular List	247
Section-Specific CPT Coding Guidelines	248
Common CPT Coding Guidelines: Evaluation and Management Section	248
Identifying the Place of Service	249
Identifying the Patient Status	249
Determining the Level of Service Provided	250
Key Components and Contributing Factors.	250
History.	250
Levels of History.	250
Examination.	251
Levels of Examination.	251
Medical Decision Making.	251
Number of Diagnoses and Management Options.	251
Amount and Complexity of Data Reviewed.	251
Risk of Complications and Morbidity or Mortality.	251
Complexity Levels in Medical Decision Making.	251
Factors That Contribute to E/M Complexity	251
Counseling.	251
Nature of the Presenting Problem.	251
Coordination of Care.	251
Time.	251
Common CPT Coding Guidelines: Anesthesia	252
Anesthesia Formula	252
Basic Unit Value (B)	252
Time Units (T)	252
Modifying Units (M)	252
Qualifying Circumstances (QC).	252
Physical Status Modifiers.	252
Conversion Factors	253
Calculating Anesthesia Services	253
Common CPT Coding Guidelines: Surgical Section	254
Surgical Package Definition	254
NCCI Edits and Unbundled Codes	254
Integumentary System	254
Excision of Lesions—Benign or Malignant	254
Levels of Closure (Repair)	254
Listing Services for Wound Repair	255
Musculoskeletal System	255
Fractures	255
Maternity Care and Delivery	255
Common CPT Coding Guidelines: Radiology Section	256
Common CPT Coding Guidelines: Pathology and Laboratory Section	256
Common CPT Coding Guidelines: Medicine Section	256
Immune Globulins	256
Immunization for Vaccines or Toxoids	256
Vaccines/Toxoids Codes.	256
Home Health Procedures and Services	257
HCPCS Code Set and Manual	257
Common HCPCS Coding Guidelines	257
Ambulance Transport	257
Medical and Surgical Supplies	257
Durable Medical Equipment	258
Closing Comments	258
Legal and Ethical Issues	258
Summary of Scenario	258
Summary of Learning Objectives	259
Connections	260
14 Basics of Health Insurance	261
Learning Objectives	261
Vocabulary	261
Scenario	261
Purpose of Health Insurance	262
Contract with Patients	262
Health Insurance Plans	262
Government-Sponsored Health Insurance Plans	262
Employer-Sponsored Group Policies	262
Individual Health Insurance Plans	262
The Affordable Care Act	262
Benefits	263
Hospitalization	263
Surgical	263
Basic Medical	263
Disability (Loss of Income) Protection	264
Dental Care	264
Vision Care	264
Medicare Supplement	264
Liability Insurance	264
Life Insurance	265
Long-Term Care Insurance	265
Premiums	265
Health Insurance Identification Card	265
Verifying Eligibility of Services	266
Accessing Healthcare	268
Participating Provider Contracts	268
Contracted Fee Schedules	269
How Reimbursements Are Determined	269
Usual, Customary, and Reasonable Fees	269
Indemnity Schedules	269
Service Benefit Plans	269
Resource-Based Relative Value Scale	269
Privately Sponsored Health Insurance Plans	270
Blue Cross/Blue Shield	270
Other Commercial Insurances	270
Managed Care Organizations	270
Models of Managed Care Plans	270
Health Maintenance Organization	270
Independent Physician Association	270
Staff Model	271
Group Model	271
Preferred Provider Organization	271
Exclusive Provider Organization	271
Referrals	272
Preauthorization for Surgical Procedures	272
Utilization Management/Utilization Review	274
Government-Sponsored Plans	274
Medicare	274
Medicaid	275
Children’s Health Insurance Program	275
TRICARE	276
Civilian Health and Medical Program of the Veterans Administration	277
Workers’ Compensation	277
Employer-Established Self-Funded Plans	277
Closing Comments	277
Patient Education	277
Legal and Ethical Issues	277
Summary of Scenario	278
Summary of Learning Objectives	278
Connections	279
15 Medical Billing and Reimbursement	280
Learning Objectives	280
Vocabulary	280
Scenario	280
Steps in Medical Billing	281
Types of Information Found in the Patient’s Billing Record	282
Managed Care Policies and Procedures	283
Precertification	284
Submitting Claims to Different Third-Party Payers	285
Generating Electronic Claims	285
Electronic Claims Submission	285
Direct Billing	285
Clearinghouse Submissions	285
Completing the CMS-1500 Health Insurance Claim Form	286
Section 1: Carrier—Block 1 (Figure 15-2)	286
Section 2: Patient and Insured Information—Blocks 1a to 13 (Figure 15-3)	286
Blocks 1a, 4, 7, and 11(a-d)	286
Blocks 2, 3, 5, 6, and 10 a-c	286
Block 9	286
Blocks 12 and 13	287
Section 3a: Physician or Supplier Information—Blocks 14 to 23 (Figure 15-6)	288
Block 14	288
Date of Current Illness, Injury, or Pregnancy (LMP).	288
Block 15	288
Other Date.	288
Block 16	288
Dates Patient Unable to Work in Current Occupation.	288
Block 17 and 17b	288
Name of Referring Provider or Other Source.	288
Block 18	288
Hospitalization Dates Related to Current Services.	288
Block 19	288
Additional Claim Information (Designated by NUCC).	288
Block 20	288
Outside Lab?/$Charges.	288
Block 21	288
Diagnosis or Nature of Illness or Injury.	288
Block 22	288
Resubmission Code/Optional Reference Number.	288
Block 23	288
Prior Authorization Number.	288
Section 3b: Physician or Supplier Information—Blocks 24 to 33 (Figure 15-7)	288
Block 24	290
Procedures and Charges.	290
Block 25 to 33	290
Facility Information.	290
Accurate Coding to Prevent Fraud and Abuse	294
Upcoding and Downcoding	294
Preventing Rejection of a Claim	295
Communicating with Providers About Third-Party Requirements	295
Checking the Status of a Claim	295
Explanation of Benefits	295
Reading the Explanation of Benefits	295
Rejected Claims	297
Denied Claims	297
Medical Necessity	297
The Patient’s Financial Responsibility	298
Allowed Amount	299
Calculating the Coinsurance and Deductible	299
Discussing Patients’ Financial Responsibility	299
Showing Sensitivity When Discussing Patients’ Finances	300
Closing Comments	301
Patient Education	301
Legal and Ethical Issues	301
Summary of Scenario	301
Summary of Learning Objectives	301
Connections	303
Unit Four Medical Office Administrative Functions	304
16 Patient Accounts, Collections, and Practice Management	304
Learning Objectives	304
Vocabulary	304
Scenario	304
Bookkeeping in the Healthcare Facility	305
Patient Account Records	305
Entering and Posting Transactions in Patient Accounts	305
Posting Charges	305
Posting Payments	310
Posting Adjustments	310
Special Bookkeeping Entries for Patient Account Records	311
Credit Balances	311
Third-Party Payments	313
Refunds	313
Interacting With Third-Party Representatives	313
Payment at the Time of Service	313
Displaying Sensitivity When Requesting Payment	314
Billing After a Payment Agreement Has Been Made	314
Using Credit for Medical Services	314
Truth in Lending Act	314
Obtaining Credit Information	314
Monthly Patient Account Statements	314
Medicare Advance Beneficiary Notices	315
Professional Courtesy	315
Billing Minors	316
Medical Care for Those Who Cannot Pay	316
Fees in Hardship Cases	316
Pitfalls of Fee Adjustments	317
Collection Procedures	318
When to Start Collection Procedures	318
Preparing Patient Accounts for Collection Activity	318
Collection Phone Calls	318
General Rules for Telephone Collections	319
What to Do	319
What Not to Do	319
Collection Letters	319
Personal Finance Interviews	320
Special Collection Situations	320
Tracing “Skips”	320
Suggestions for Tracing Skips	320
Claims Against Estates	320
Bankruptcy	321
Using a Collection Agency	321
Working With the Collection Agency	321
Making the Decision to Sue	321
Small Claims Court	322
Special Bookkeeping Entries for Collections	322
Nonsufficient Funds Checks (NSF)	322
Posting Collection Agency Transactions	322
Managing Funds in the Healthcare Facility	322
Accounts Receivable (A/R)	322
Accounts Payable (A/P)	323
Invoices and Statements	323
Paying for Purchases	323
Closing Comments	323
Patient Education	323
Legal and Ethical Issues	323
Summary of Scenario	323
Summary of Learning Objectives	324
Connections	325
17 Banking Services and Procedures	326
Learning Objectives	326
Vocabulary	327
Scenario	326
Banking In Today’s Business World	327
Common Types of Bank Accounts	328
Checking Accounts	328
Savings Accounts	328
Money Market Savings Account	328
Signature Cards	329
Online Banking	329
Customer-Oriented Banking	329
Checks	329
Routing and Account Numbers	329
American Bankers Association Number	330
Types of Negotiable Instruments	330
Personal Check	330
Cashier’s Check	330
Money Order	330
Business Checks	330
Voucher Check	331
How Checks Are Processed from One Bank to Another	331
Nonsufficient Funds Check (NSF)	331
Cash Management	331
Debit Cards	333
Advantages of Using Debit Cards	333
Credit Cards	333
Precautions for Accepting Credit and Debit Cards	333
Banking Procedures in the Ambulatory Care Setting	334
Making Bank Deposits	334
Preparing the Deposit	334
Check Endorsements	335
Types of Endorsements	335
Blank Endorsement.	335
Restrictive Endorsement.	335
Special Endorsement.	335
Qualified Endorsement.	336
Methods of Endorsement	336
Stamp.	336
Signature.	336
Using Checks for Healthcare Facility Expenses	336
How to Write a Check	336
Writing Cash Checks	336
Mailing Checks	336
Overdraft	336
Stop-Payments	337
Paying Bills to Maximize Cash Flow	337
Online Bill Pay	337
Direct Deposit	337
Reward Credit Cards	337
Bank Statements and Reconciliation	337
What to Do When the Balances Do Not Match	340
Bank Statement Reconciliation Formula	340
Closing Comments	340
Patient Education	340
Legal and Ethical Issues	340
Summary of Scenario	340
Summary of Learning Objectives	341
Connections	342
18 Supervision and Human Resource Management	343
Learning Objectives	343
Vocabulary	344
Scenario	343
Today’s Office Manager	344
Responsibilities of the Medical Office Manager	344
Chain of Command in the Medical Office	345
The Power of Motivation	345
Keeping the Management Relationship Professional	346
Use of Incentives and Employee Recognition	346
Abuse of Power and Authority	347
Creating a Team Atmosphere	347
Recognize and Overcome Barriers to Communication	347
Introducing a New Office Manager	348
Preventing Burnout	348
Finding the Right Employee for the Job	349
Job Description	349
Reviewing Applications	350
Arranging the Personal Interview	350
The Interview	351
Follow-Up Activities	351
Selecting the Right Applicant	352
Paperwork for New Employees	352
Orientation and Training: Critical Factors for Successful Employees	352
Staff Development and Training	355
Staff Meetings	355
Delegation of Duties	356
Using Performance Reviews Effectively	357
Problem Employees	357
Terminating Employees	358
Fair Salaries and Raises	359
Closing Comments	359
Legal and Ethical Issues	359
Summary of Scenario	359
Summary of Learning Objectives	360
Connections	361
19 Medical Practice Marketing and Customer Service	362
Learning Objectives	362
Vocabulary	363
Scenario	362
Marketing Needs of the Healthcare Facility	363
Identifying the Target Market	363
SWOT Analysis	364
Strengths and Weaknesses.	364
Opportunities and Threats.	364
Marketing Tools	364
Promoting the Practice Through Community Involvement	364
Automated Phone Calls	365
Newsletters and Blogs	365
Print Ads in Magazines and Newspapers	365
Internet Marketing	365
Advertising Versus Public Relations	366
Marketing Through Social Media	366
Building a Medical Practice Website	366
Choosing a Website Name	366
Creating a Site Map	367
Home Page	367
About Us Page	367
Testimonials or Information Page	367
Specials Page	367
Contact Us Page	367
Designing Pages	367
Increasing Website Traffic	368
High-Quality Customer Service	368
Loyal Patients	368
A Helpful Attitude	369
Identifying with Patients	369
What Do Patients Expect?	369
Patient Surveys	370
Problem Patients	371
“Welcome to Our Office” Packet	371
Introduction to the Medical Office	371
Missed Appointments and Cancellation Policy	372
Medical Office’s Financial Policy	372
Patient Information Web Portal	372
List of Community Resources	372
The Patient Navigator	374
Patient-Centered Medical Home	374
Electronic Technology in Professional Communication	375
Telemedicine	375
Closing Comments	375
Patient Education	375
Legal and Ethical Issues	375
Summary of Scenario	376
Summary of Learning Objectives	376
Connections	377
Unit Five Fundamentals of Clinical Medical Assisting	378
20 Infection Control	378
Learning Objectives	378
Vocabulary	379
Scenario	378
Disease	379
The Chain of Infection	380
The Inflammatory Response	382
Types of Infections	383
Acute Infection	383
Chronic Infection	383
Latent Infection	383
Opportunistic Infections	383
OSHA Standards for the Healthcare Setting	384
Exposure Control Plan	384
The Bloodborne Pathogens Standard	384
Compliance Guidelines	386
Barrier Protection	386
Environmental Protection	386
Housekeeping Controls	389
Hepatitis B Vaccination	391
Postexposure Follow-Up	391
Aseptic Techniques: Preventing Disease Transmission	393
Hand Washing	393
Sanitization	396
Ultrasonic Sanitization	396
Disinfection	398
Sterilization	398
Role of the Medical Assistant in Asepsis	398
Closing Comments	398
Patient Education	398
Legal and Ethical Issues	399
Summary of Scenario	400
Summary of Learning Objectives	400
Connections	401
21 Patient Assessment	402
Learning Objectives	402
Vocabulary	403
Scenario	402
Medical History	403
Collecting the History Information	403
Components of the Medical History	404
Understanding and Communicating with Patients	404
Sensitivity to Diverse Patient Groups	405
Therapeutic Techniques	409
Active Listening Techniques	409
Nonverbal Communication	410
Environmental Factors	411
Open-Ended Questions or Statements	411
Closed Questions	411
Interviewing the Patient	412
Interview Barriers	413
Providing Unwarranted Assurance	413
Giving Advice	413
Using Medical Terminology	413
Leading Questions	414
Talking Too Much	414
Defense Mechanisms	414
Communication Across the Lifespan	414
Recognizing and Responding to Verbal and Nonverbal Communications	416
Assessing the Patient	416
Signs and Symptoms	416
Documentation	417
Documentation Guidelines	417
Medical Terminology	419
Documentation Methods	423
Problem-Oriented Medical Record	423
Source-Oriented Medical Record	425
Electronic Health Records	425
Closing Comments	426
Patient Education	426
Legal and Ethical Issues	426
Important Provisions of the Health Insurance Portability and Accountability Act (HIPAA)	427
Summary of Scenario	427
Summary of Learning Objectives	428
Connections	429
22 Patient Education	430
Learning Objectives	430
Scenario	430
Patient Education and Models of Health and Illness	431
Patient Factors That Affect Learning	433
Perception of Disease Versus Actual State of Disease	433
Patient’s Need for Information	433
Patient’s Age and Developmental Level	433
Patient’s Mental and Emotional State	433
Influence of Multicultural and Diversity Factors on Patient Education	433
Patient Learning Style	434
Impact of Physical Disabilities	434
The Teaching Plan	435
Assess the Patient’s Learning Needs	435
Determine the Teaching Priorities	435
Decide on the Appropriate Teaching Materials	436
Decide on the Appropriate Teaching Methods	438
Implement the Teaching Plan	439
Closing Comments	441
Legal and Ethical Issues	441
HIPAA Applications	441
Summary of Scenario	441
Summary of Learning Objectives	442
Connections	443
23 Nutrition and Health Promotion	444
Learning Objectives	444
Vocabulary	445
Scenario	444
Nutrition and Dietetics	446
Nutrients	446
Nutrient Components	447
Carbohydrates	447
Recommendations for Carbohydrate Consumption	448
Fats	449
Saturated and Unsaturated Fatty Acids.	449
Foods High in Saturated Fat.	449
Cholesterol.	450
Recommendations for Fat Consumption	450
Antioxidants.	450
Proteins	451
Recommendations for Protein Consumption	451
Vitamins (Micronutrients)	452
Minerals (Electrolytes)	455
Water	455
Choose My Plate	458
Nutritional Status Assessment	459
Body Fat Measurement	459
Body Mass Index	460
Therapeutic Nutrition	461
Modifying a Diet	461
Liquid Diet	462
Soft or Light Diet	462
Mechanical Soft Diet	462
Bland Diet	462
Elimination Diet	462
Gluten-Free Diets	462
High- or Low-Fiber Diet	462
Diabetic Diet	463
Heart-Healthy Diet	464
Reading Food Labels	466
How to Use Label Information	467
Organic Foods Production Act	468
Food-Borne Diseases	468
Environmental Contamination of Food	468
Eating Disorders	468
Obesity	469
Medications for Obesity	469
Bariatric Surgery for Obesity	469
Health Promotion	470
Exercise	470
Stress Management	470
Preventive Services and Health Screening	471
Preventive Services for Women	471
Preventive Services for Men	471
Closing Comments	471
Patient Education	471
Legal and Ethical Issues	471
Summary of Scenario	471
Summary of Learning Objectives	472
Connections	473
24 Vital Signs	474
Learning Objectives	474
Vocabulary	474
Scenario	474
Factors That May Influence Vital Signs	475
Temperature	476
Physiology	476
Fever	476
Temperature Readings	477
Types of Thermometers and Their Uses	478
Digital Thermometer	478
Tympanic Thermometer	479
Temporal Artery Scanner	481
Axillary Thermometer	482
Disposable Thermometer	483
Pulse	483
Pulse Sites	484
Characteristics of a Pulse	486
Rate	486
Rhythm	486
Volume	487
Determining the Pulse Rate	487
Radial and Apical Pulse Rates	487
Femoral, Popliteal, and Pedal Pulses	487
Respiration	488
Physiology	488
Characteristics of Respirations	488
Counting Respirations	489
Blood Pressure	490
Factors Affecting Blood Pressure	490
Evaluating the Blood Pressure	490
Measuring Blood Pressure	492
Effects of Body Position on Blood Pressure Measurement	495
Korotkoff Sounds	496
Phase I	496
Phase II	496
Phase III	497
Phase IV	497
Phase V	497
Palpatory Method	497
Anthropometric Measurements	497
Measuring Weight and Height	497
Weight	500
Height	500
Closing Comments	500
Patient Education	500
Legal and Ethical Issues	501
Summary of Scenario	501
Summary of Learning Objectives	502
Connections	503
25 Assisting with the Primary Physical Examination	504
Learning Objectives	504
Vocabulary	504
Scenario	504
Anatomy and Physiology	505
Structural Development	505
Cells	505
Tissues	505
Organs	506
Body Cavities	506
Systems	506
Primary Care Provider	506
Physical Examination	508
Preparing for the Physical Examination	508
Role of the Medical Assistant in the Physical Examination	508
Preparing the Examination Room.	508
Assisting the Patient.	508
Assisting the Provider.	508
Supplies and Instruments Needed for the Physical Examination	509
Ophthalmoscope.	509
Tongue Depressor.	509
Otoscope.	509
Tuning Fork.	509
Tape Measure.	509
Stethoscope.	510
Reflex Hammer.	510
Gloves.	510
Additional Supplies.	510
Principles of Body Mechanics	510
Transferring a Patient	511
Assisting with the Physical Examination	514
Positioning and Draping the Patient for the Physical Examination	514
Fowler’s Position	514
Semi-Fowler’s Position	514
Supine (Horizontal Recumbent) Position	514
Dorsal Recumbent Position	514
Lithotomy Position	514
Sims Position	515
Prone Position	515
Knee-Chest Position	515
Trendelenburg Position	515
Methods of Examination	521
Inspection	521
Palpation	521
Percussion	521
Auscultation	521
Mensuration	522
Manipulation	522
Examination Sequence	522
General Appearance	522
Speech	522
Breath Odors	523
Skin	523
Head	523
Eyes	523
Ears	523
Nose and Sinuses	523
Mouth and Throat	523
Neck	523
Chest	523
Abdomen	524
Reflexes	524
Breast and Testicles	524
Rectum	524
Closing Comments	526
Patient Education	526
Legal and Ethical Issues	526
HIPAA Applications	526
Summary of Scenario	526
Summary of Learning Objectives	526
Connections	528
Unit Six Assisting with Medications	529
26 Principles of Pharmacology	529
Learning Objectives	529
Vocabulary	529
Scenario	529
Government Regulation	530
Controlled Substances	531
Regulation of Controlled Substances	531
Drug Abuse	533
Drug Names	533
Approaches to Studying Pharmacology	534
Drug Reference Materials	534
Package Inserts	534
Physicians’ Desk Reference	534
United States Pharmacopeia/National Formulary	535
Learning About Drugs	535
Dispensing Drugs	535
Prescription Drugs	536
Drug Interactions with the Body	540
Drug Absorption	540
Oral Route	540
Parenteral Route	541
Mucous Membrane Absorption	541
Topical Absorption	541
Drug Distribution	541
Drug Action	542
Drug Metabolism	542
Drug Excretion	543
Factors Affecting Drug Action	543
Body Weight	543
Age	543
Gender	543
Time of Day	544
Pathologic Factors	544
Immune Responses	544
Psychological Factors	544
Tolerance	544
Accumulation	544
Idiosyncrasy	544
Drug-Drug Interactions	544
Classifications of Drug Actions	545
Examples of Drug Classifications	545
Adrenergics	545
Adrenergic Blockers	545
Analgesics	545
Anesthetics	545
Antacids/Proton-Pump Inhibitors	545
Antianxiety Agents	545
Antibiotics	545
Anticholinergics	546
Anticoagulants	546
Anticonvulsants	546
Antidepressants	546
Antiemetics	546
Antifungals	546
Antihistamines	546
Antihypertensive Agents	546
Antiinflammatory Agents	546
Antimigraine Agents	546
Antineoplastics	547
Antipsychotics	547
Antipruritics	547
Antipyretics	547
Antispasmodics	547
Antitussives	547
Antiviral Agents	547
Bronchodilators	547
Cathartics (Laxatives)	547
Central Nervous System Stimulants	547
Contraceptives	547
Decongestants	547
Diuretics	548
Erectile Dysfunction Agents	548
Expectorants	548
Hematopoietic Agents	548
Hemostatic Agents	548
Hormone Replacement Agents	548
Hypnotics (Sedatives)	548
Lipid-Lowering Agents	548
Miotics	548
Monoclonal Antibodies	548
Mydriatic Agents (Anticholinergic)	548
Narcotics	549
Oral Hypoglycemic Agents	549
Osteoporosis Agents	549
Respiratory Corticosteroid Agents	549
Herbal and Alternative Therapies	553
Herbal Products	553
Regulation of Herbal Products	553
Commonly Used Herbal Products	553
Alternative Therapies	553
Acupuncture	553
Chiropractic Care	553
Mind-Body Therapy	553
Homeopathic Medicine	555
Closing Comments	556
Patient Education	556
Therapeutic Communication with Patients from Diverse Cultures	556
Legal and Ethical Issues	556
HIPAA Applications	556
Summary of Scenario	557
Summary of Learning Objectives	557
Connections	558
27 Pharmacology Math	559
Learning Objectives	559
Vocabulary	559
Scenario	559
Drug Labels	559
Math Basics	561
Fractions	561
Decimals	561
Percent	562
Ratio and Proportion	562
Step 1.	562
Step 2.	562
Step 3	562
Step 4	562
Rounding Calculations	563
Systems of Measurement	563
Metric System	564
Household Measurements	565
Conversions Among Systems of Measurement	565
Calculating Drug Dosages for Administration	566
Calculating Dosages	566
Problem 1: Preparing an Injectable Dose	566
Problem 2: Determining an Oral Dose	567
More Sample Problems	567
Problem 1.	567
Problem 2.	568
Pediatric Dosages	569
Calculating the Dose	569
Dosages Based on Body Weight	569
Example.	570
Reconstituting Powdered Injectable Medications	571
Example.	571
Closing Comments	571
Legal and Ethical Issues	571
Summary of Scenario	572
Summary of Learning Objectives	572
Connections	573
28 Administering Medications	574
Learning Objectives	574
Vocabulary	574
Scenario	574
Safety in Drug Administration	575
Patient Assessment Factors	576
Approaches to Special Patient Populations	577
Assessment of the Patient’s Environment	578
Suggested Questions for Gathering Medication Information	578
Drug Forms and Administration	578
Solid Oral Dosage Forms	579
Liquid Oral Dosage Forms	579
Rectal Administration	580
Vaginal Administration	580
Administration of Medications by Mouth	580
Nasal Administration	582
Topical Forms	582
Lotions	582
Liniments	582
Ointments	582
Transdermal Patches	582
Parenteral Medication Forms	583
Ampule	583
Single-Dose Vial	583
Multidose Vial	587
Prefilled Syringe	587
Parenteral Medication Equipment	587
Needle Gauge	588
Needle Length	588
Syringes	588
Specialty Syringe Units	590
Parenteral Administration	590
Intradermal Injections	591
Subcutaneous Injections	595
Intramuscular Injections	601
Deltoid Site.	602
Vastus Lateralis (Thigh) Site.	602
Dorsogluteal (Gluteus Medius) Site.	606
Ventrogluteal (Gluteus Medius) Site.	607
Z-Track Intramuscular Injection	607
Closing Comments	609
Patient Education	609
Legal and Ethical Issues	610
Summary of Scenario	613
Summary of Learning Objectives	613
Connections	614
Unit Seven Assisting with Medical Specialties	615
29 Safety and Emergency Practices	615
Learning Objectives	615
Vocabulary	616
Scenario	615
Safety in the Healthcare Facility	616
Patient Safety	616
Employee Safety	616
Environmental Safety	619
Disposal of Hazardous Waste	622
Emergency Preparedness	622
Community Resources for Emergency Preparedness	622
Assisting with Medical Emergencies	624
Emergency Supplies	624
Defibrillators	626
Precautions for Automated External Defibrillators	626
General Rules for Emergencies	627
Telephone Screening	628
Management of On-Site Emergencies	629
Life-Threatening Emergencies	629
Unresponsive Patient	629
Cardiac Emergencies	633
Choking	635
Cerebrovascular Accident (Stroke)	637
Shock	638
Common Office Emergencies	639
Fainting (Syncope)	639
Poisoning	639
Animal Bites	641
Insect Bites and Stings	641
Asthma Attacks	641
Seizures	642
Abdominal Pain	643
Sprains and Strains	643
Fractures	643
Burns	644
Tissue Injuries	644
Nosebleeds (Epistaxis)	646
Head Injuries	646
Foreign Bodies in the Eye	646
Heat and Cold Injuries	646
Dehydration	646
Diabetic Emergencies	647
Closing Comments	648
Patient Education	648
Legal and Ethical Issues	648
Summary of Scenario	649
Summary of Learning Objectives	649
Connections	651
30 Assisting in Ophthalmology and Otolaryngology	652
Learning Objectives	652
Vocabulary	653
Scenario	652
Examination of the Eye	653
Anatomy and Physiology of the Eye	653
The Eyeball	653
Vision	654
Disorders of the Eye	654
Refractive Errors	654
Hyperopia (Farsightedness).	655
Myopia (Nearsightedness).	655
Presbyopia.	655
Astigmatism.	655
Signs and Symptoms of Refractive Errors	655
Treatment of Refractive Errors	655
Strabismus	656
Nystagmus	656
Infections of the Eye	656
Disorders of the Eyeball	657
Corneal Abrasion	657
Cataract	657
Glaucoma	657
Macular Degeneration	658
Diagnostic Procedures	659
Distance Visual Acuity	660
Near Visual Acuity	662
Ishihara Color Vision Test	663
Treatment Procedures	664
Eye Irrigation	664
Instillation of Eye Medication	666
Aseptic Procedures in Ophthalmology	668
Examination of the Ear	668
Anatomy and Physiology of the Ear	668
Outer (External) Ear	668
Middle Ear	668
Inner Ear	668
Disorders of the Ear	669
Hearing Loss	669
Otitis	670
Impacted Cerumen	672
Ménière’s Disease	672
Diagnostic Procedures	673
Tuning Fork Testing	673
Audiometric Testing	673
Aseptic Procedures in Otology	675
Treatment Procedures	675
Ear Irrigation	675
Instilling Otic Medications	677
Examination of the Nose and Throat	678
Closing Comments	680
Patient Education	680
Legal and Ethical Issues	680
HIPAA Requirements	680
Americans with Disabilities Act Requirements	680
Summary of Scenario	681
Summary of Learning Objectives	681
Connections	682
31 Assisting in Dermatology	683
Learning Objectives	683
Vocabulary	683
Scenario	683
Anatomy and Physiology	684
Epidermis	684
Dermis	685
Subcutaneous Layer	685
Diseases and Disorders	685
Skin Lesions	685
Infections	685
Bacterial Infections	685
Impetigo.	685
Acne.	687
Rosacea.	687
Furuncles and Carbuncles.	688
Cellulitis.	688
Fungal Infections (Dermatophytoses)	688
Viral Infections	689
Warts.	689
Herpes Simplex (Cold Sores).	689
Herpes Zoster (Shingles).	689
Parasites	690
Inflammatory Skin Disorders	690
Seborrheic Dermatitis	690
Contact Dermatitis	690
Eczema (Atopic Dermatitis)	691
Autoimmune Skin Disorders	692
Psoriasis	692
Systemic Lupus Erythematosus	692
Thermal Injuries	692
Superficial (First-Degree) Burn	693
Partial-Thickness (Second-Degree) Burn	693
Treatment of Minor Burns	693
Full-Thickness (Third-Degree) Burn	694
Cold Injuries	694
Benign and Malignant Neoplasms	694
Neoplasms of the Skin	695
Dermatologic Procedures	697
Assisting with a Dermatologic Examination	697
Skin Testing for Allergies	697
Percutaneous Test.	697
Patch Test.	697
Intradermal (Intracutaneous) Test.	698
Radioallergosorbent Test.	698
Treatment of Allergies	698
Appearance Modification Procedures	698
Chemical Peel (Chemexfoliation).	698
Dermabrasion.	698
Laser Resurfacing (Photothermolysis).	698
Botox Injections.	698
Closing Comments	699
Patient Education	699
Legal and Ethical Issues	699
Summary of Scenario	699
Summary of Learning Objectives	699
Connections	700
32 Assisting in Gastroenterology	701
Learning Objectives	701
Vocabulary	701
Scenario	701
Anatomy and Physiology	702
Diseases of the Gastrointestinal System	703
Characteristics of the GI System	704
Cancers of the Gastrointestinal Tract	706
Disorders of the Esophagus and Stomach	706
Hiatal Hernia	706
Gastroesophageal Reflux Disease	707
Gastric and Duodenal Ulcers	708
Pyloric Stenosis	709
Intestinal Disorders	709
Food-Borne Illness	709
Irritable Bowel Syndrome	710
Acute Appendicitis	711
Crohn’s Disease	711
Ulcerative Colitis	711
Celiac Disease	712
Diverticular Disease	712
Hernias of the Abdomen	713
Hemorrhoids	713
Diseases of the Liver and Gallbladder	713
Cirrhosis	713
Hepatitis	714
Viral Hepatitis	714
Diagnosis and Treatment	714
Cholelithiasis (Gallstones)	715
Signs and Symptoms	715
Diagnosis and Treatment	716
The Medical Assistant’s Role in the Gastrointestinal Examination	716
Assisting with the Examination	716
Diagnostic Procedures	716
Sigmoidoscopy and Colonoscopy Examinations	718
Laboratory Tests	719
Occult Blood Screening	719
Proctologic Examination	721
Closing Comments	721
Patient Education	721
Legal and Ethical Issues	721
Summary of Scenario	722
Summary of Learning Objectives	722
Connections	723
33 Assisting in Urology and Male Reproduction	724
Learning Objectives	724
Vocabulary	724
Scenario	724
Anatomy and Physiology of the Urinary System	725
Disorders of the Urinary System	726
Urinary Incontinence	728
Urinary Tract Infections and Inflammations	728
Urethritis	728
Cystitis	728
Pyelonephritis	729
Treatment of Urinary Tract Infections	729
Glomerulonephritis	729
Urinary Tract Disorders and Cancers	729
Renal Calculi	729
Hydronephrosis	730
Polycystic Kidneys	730
Bladder Cancer	731
Renal Carcinoma	732
Wilms Tumor	732
Renal Failure	732
Treatment	732
Pediatric Urologic Disorders	733
Nocturnal Enuresis	733
Urinary Reflux Disorder	734
Cryptorchidism	734
Anatomy and Physiology of the Male Reproductive System	734
The Penis	735
Hormone Production	735
Disorders of the Male Reproductive Tract	735
Diseases of the Prostate	735
Prostatitis	735
Benign Prostatic Hyperplasia	736
Prostate Cancer	736
Pathologic Conditions of the Genital Organs	737
Epididymitis	737
Balanitis	737
Hydrocele	737
Testicular Cancer	737
Erectile Dysfunction	739
Infertility	740
Sexually Transmitted Infections	740
Bacterial Sexually Transmitted Infections	740
Viral Sexually Transmitted Infections	741
Human Immunodeficiency Virus	741
The Medical Assistant’s Role in Urologic and Male Reproductive Examinations	743
Assisting with a Urologic Examination	743
Assisting with a Male Reproductive Examination	743
Vasectomy	743
Closing Comments	744
Patient Education	744
Legal and Ethical Issues	744
HIPAA Applications	744
Summary of Scenario	745
Summary of Learning Objectives	745
Connections	746
34 Assisting in Obstetrics and Gynecology	747
Learning Objectives	747
Vocabulary	747
Scenario	747
Anatomy and Physiology	748
Female Reproductive System	748
Breast Tissue	749
Menstruation	749
Follicular Phase (Proliferative Phase)	749
Luteal Phase (Secretory Phase)	750
Menstrual Phase	750
Contraception	750
Barrier Methods	750
Hormonal Contraceptives	751
Intrauterine Devices	752
Permanent Methods	753
Gynecologic Diseases and Disorders	753
Menstrual Disorders and Conditions	753
Endometriosis	753
Infections	754
Candidiasis	754
Bacterial Vaginosis	755
Cervicitis	755
Pelvic Inflammatory Disease	755
Sexually Transmitted Infections	756
Benign Tumors	758
Fibroid Tumors	758
Ovarian Cysts	758
Fibrocystic Breast Disease	758
Malignant Tumors	759
Cervical Cancer	759
Endometrial Cancer	763
Ovarian Cancer	763
Breast Cancer	763
Positional Disorders of the Pelvic Region	766
Pregnancy	767
Anatomy and Physiology	767
First Trimester	767
Second Trimester	767
Third Trimester	768
Parturition	768
Pregnancy Complications	769
Infertility and Abortions	769
Placental Abnormalities	769
Maternal Disorders	770
Gestational Diabetes.	770
Hypertension.	770
Menopause	770
The Medical Assistant’s Role in Gynecologic and Obstetric Procedures	771
Examination Preparation	771
Assisting with the Examination	773
Breast Examination	773
Abdominal Examination	773
Pelvic Examination	773
Postexamination Duties	774
Diagnostic Testing	774
Sonography	774
Mammography	774
Pregnancy Testing	775
Closing Comments	775
Patient Education	775
Legal and Ethical Issues	776
Summary of Scenario	777
Summary of Learning Objectives	777
Connections	778
35 Assisting in Pediatrics	779
Learning Objectives	779
Vocabulary	779
Scenario	779
Normal Growth and Development	780
Growth Patterns	780
Denver II Developmental Screening Test	781
Developmental Patterns	781
Developmental Theories	784
Pediatric Diseases and Disorders	785
Gastrointestinal Disorders	785
Colic	785
Diarrhea	786
Failure to Thrive	787
Obesity	787
Respiratory Disorders	788
Common Cold	788
Otitis Media	788
Croup	789
Pertussis (Whooping Cough)	789
Bronchiolitis	789
Respiratory Syncytial Virus	790
Asthma	790
Influenza	790
Infectious Diseases	791
Conjunctivitis	791
Tonsillitis	791
Fifth Disease	791
Hand-Foot-and-Mouth Disease	791
Varicella (Chickenpox)	791
Meningitis	792
Hepatitis B	792
Reye’s Syndrome	792
Inherited Disorders	794
Cystic Fibrosis	794
Duchenne’s Muscular Dystrophy	794
Immunizations	795
The Pediatric Patient	802
Well-Child Visits	802
Sick-Child Visits	803
The Medical Assistant’s Role in Pediatric Procedures	803
Measurement	804
Assisting with the Examination	809
Obtaining a Urine Sample	811
The Adolescent Patient	813
Injury Prevention	813
Child Abuse	813
Closing Comments	814
Patient Education	814
Legal and Ethical Issues	814
Summary of Scenario	815
Summary of Learning Objectives	815
Connections	816
36 Assisting in Orthopedic Medicine	817
Learning Objectives	817
Vocabulary	817
Scenario	817
Anatomy and Physiology of the Musculoskeletal System	818
Muscles	818
Bones	818
Joints	821
Types of Joints	821
Ligaments, Tendons, and Bursae	822
Musculoskeletal Diseases and Disorders	823
Muscular Disorders	823
Fibromyalgia	823
Myasthenia Gravis	826
Sprains, Strains, and Spasms	826
Skeletal Disorders	827
Fractures	827
Osteomalacia	827
Osteoporosis	829
Spinal Column Disorders	830
Abnormal Spinal Curvatures	830
Herniated Disk	831
Joint Disorders	831
Dislocation	831
Gout	831
Lupus	832
Infectious Arthritis	833
Lyme Disease	833
Osteoarthritis	833
Rheumatoid Arthritis	834
Tendonitis and Bursitis	834
Carpal Tunnel Syndrome	835
The Medical Assistant’s Role in Assisting with Orthopedic Procedures	835
Assisting With the Examination	835
Specialized Diagnostic Procedures in Orthopedics	835
Range-of-Motion Evaluation	835
Muscle Strength Evaluation	836
Radiology	836
Therapeutic Modalities	837
General Principles of Cold Application	837
Heat Modalities	838
Paraffin Bath	839
Heating Pads	839
Therapeutic Ultrasonography	840
Massage and Exercise	840
Electrical Muscle Stimulation	840
Ambulatory Devices	840
Crutches	840
Walkers	842
Canes	843
Wheelchairs	843
Management of Fractures	844
Closing Comments	847
Patient Education	847
Legal and Ethical Issues	848
Summary of Scenario	848
Summary of Learning Objectives	848
Connections	849
37 Assisting in Neurology and Mental Health	850
Learning Objectives	850
Vocabulary	850
Scenario	850
Anatomy and Physiology of the Nervous System	851
Central Nervous System	852
Brain	852
Spinal Cord	852
Meninges	852
Peripheral Nervous System	854
Diseases and Disorders of the Central Nervous System	855
Cerebrovascular Disease	855
Transient Ischemic Attacks	857
Cerebrovascular Accident	857
Migraine Headache	859
Dementia and Alzheimer’s Disease	859
Epilepsy and Seizure Disorders	859
Central Nervous System Infections	860
Encephalitis	860
Meningitis	860
Brain and Spinal Cord Injuries	861
Cerebral Concussion and Contusion	861
Open and Closed Head Injuries	862
Shaken Baby Syndrome	862
Spinal Cord Injuries	862
Additional Central Nervous System Pathologies	863
Parkinson’s Disease	863
Tumors	863
Diseases of the Peripheral Nervous System	864
Multiple Sclerosis	864
Amyotrophic Lateral Sclerosis	864
Bell’s Palsy	864
Peripheral Neuropathy	864
Mental Health	864
Depressive Disorders	865
Anxiety Disorders	865
Schizophrenia	866
The Medical Assistant’s Role in the Neurologic Examination	866
Diagnostic Testing	868
Electroencephalography	868
Lumbar Puncture	870
Closing Comments	871
Patient Education	871
Legal and Ethical Issues	872
HIPAA Applications	872
Summary of Scenario	872
Summary of Learning Objectives	872
Connections	874
38 Assisting in Endocrinology	875
Learning Objectives	875
Vocabulary	875
Scenario	875
Anatomy and Physiology of the Endocrine System	876
Basic Anatomy	876
Mechanisms of Hormone Action	877
Diseases and Disorders of the Endocrine System	878
Posterior Pituitary Gland Disorder	878
Diabetes Insipidus	878
Diseases of the Anterior Pituitary	878
Growth Hormone Abnormalities	878
Disorders of the Thyroid	878
Hypothyroidism	878
Hyperthyroidism	879
Disorders of the Adrenal Glands	880
Endocrine Dysfunction of the Pancreas: Diabetes Mellitus	880
Prediabetes	881
Diabetes Mellitus Type 1	882
Diabetes Mellitus Type 2	884
Gestational Diabetes	885
Complications of Diabetes Mellitus	886
Acute Complications.	886
Chronic Complications	887
Microvascular Disease.	887
Diabetic Neuropathy.	887
Macrovascular Disease.	889
Infection.	889
Follow-Up for Patients with Diabetes	890
Developing an Education Plan for Patients Newly Diagnosed With Diabetes	890
Closing Comments	890
Patient Education	890
Legal and Ethical Issues	891
Summary of Scenario	891
Summary of Learning Objectives	891
Connections	892
39 Assisting in Pulmonary Medicine	893
Learning Objectives	893
Vocabulary	893
Scenario	893
The Respiratory System	894
Upper Respiratory Tract	894
Lower Respiratory Tract	894
Ventilation	895
Inspiration	896
Expiration	896
Respiratory System Defenses	897
Major Diseases of the Respiratory System	897
Infectious Diseases	897
Upper Respiratory Tract Infections	898
Common Cold.	898
Sinusitis.	898
Allergic Rhinitis (Hay Fever).	898
Lower Respiratory Tract Infections	899
Pneumonia.	899
Tuberculosis.	899
Chronic Obstructive Pulmonary Disease	901
Asthma	901
Pneumoconioses	905
Emphysema	905
Obstructive Sleep Apnea	906
Cancer of the Pulmonary System	907
Lung Cancer	907
Carcinoma of the Larynx	908
The Medical Assistant’s Role in Pulmonary Procedures	908
Assisting with the Examination	908
Diagnostic Procedures	908
Tuberculosis	908
Spirometry	908
Test Results.	910
Pulse Oximetry	910
Obtaining Sputum for Culture	911
Methods of Collection.	911
Bronchoscopy	912
Closing Comments	912
Patient Education	912
Legal and Ethical Issues	913
Summary of Scenario	913
Summary of Learning Objectives	913
Connections	914
40 Assisting in Cardiology	915
Learning Objectives	915
Vocabulary	915
Scenario	915
Anatomy and Physiology of the Heart	916
Layers of the Heart	916
Heart Chambers and Arteries	916
Heart Conduction	917
Diseases and Disorders of the Heart	918
Coronary Artery Disease and Myocardial Infarction	919
Diagnostic and Therapeutic Procedures	921
Hypertensive Heart Disease	922
Congestive Heart Failure	923
Orthostatic Hypotension	924
Inflammatory and Valvular Disorders	924
Rheumatic Heart Disease	924
Valve Disorders	924
Blood Vessels	924
Arteries	926
Veins	926
Vascular Disorders	926
Shock	926
Vein Disorders	926
Varicose Veins	926
Deep Vein Thrombosis	927
Arterial Disorders	928
Arteriosclerosis and Atherosclerosis	928
Aneurysm	928
Peripheral Arterial Disease	928
Diagnostic Procedures and Treatments	929
Doppler Studies	929
Angiography	929
Echocardiography	930
Cardiac Catheterization and Angioplasty	930
Cardiac Pacemakers	931
Implantable Cardioverter-Defibrillator	931
Closing Comments	931
Patient Education	931
Legal and Ethical Issues	931
Summary of Scenario	932
Summary of Learning Objectives	932
Connections	933
41 Assisting in Geriatrics	934
Learning Objectives	934
Vocabulary	934
Scenario	934
Changes in Anatomy and Physiology	936
Cardiovascular System	936
Endocrine System	938
Gastrointestinal System	938
Integumentary System	939
Musculoskeletal System	940
Osteoporosis	940
Falls	940
Nervous System	941
Alzheimer’s Disease	941
Pulmonary System	944
Sensory Organs	944
Vision	944
Cataracts, Glaucoma, and Macular Degeneration.	945
Hearing	945
Taste and Smell	946
Nutritional Status.	946
Urinary System	946
Reproductive System	947
Sleep Disorders	947
Living Arrangements	948
The Medical Assistant’s Role in Caring for the Older Patient	948
Closing Comments	949
Patient Education	949
Legal and Ethical Issues	949
Summary of Scenario	951
Summary of Learning Objectives	951
Connections	952
Unit Eight Diagnostic Procedures	953
42 Principles of Electrocardiography	953
Learning Objectives	953
Vocabulary	953
Scenario	953
The Electrical Conduction System of the Heart	954
The Cardiac Cycle	954
Polarization, Depolarization, and Repolarization	956
PQRST Complex	956
The Electrocardiograph	957
Electrocardiograph Paper	957
Electrodes and Lead Wires	958
Lead Recordings	958
Standard Leads	958
Augmented Leads	959
Precordial Leads	959
Performing Electrocardiography	959
Preparation of the Room and Patient	959
Attaching Leads to the Patient	960
Special Considerations.	961
Recording the Electrocardiogram	961
Standardization, Sensitivity, and Speed	961
The ECG Tracing and the Health Record	964
Interpretive Electrocardiographs	964
Artifacts	964
Wandering Baseline	964
Somatic Tremor	964
Alternating Current Interference	965
Interrupted Baseline	965
The ECG Strip	965
Normal Appearance of ECG Complexes	965
Rate	965
Rhythm	965
Typical ECG Rhythm Abnormalities	966
Sinus Arrhythmias	966
Atrial Arrhythmias	967
Ventricular Arrhythmias	968
Biochemical Arrhythmias	968
Pacemaker Rhythms	969
Implanted Cardioverter-Defibrillator	969
Myocardial Infarction	970
Related Cardiac Diagnostic Tests	971
Stress Test	971
Holter Monitor	972
Cardiac Event Monitor	975
Heart Scan	975
Closing Comments	976
Patient Education	976
Legal and Ethical Issues	976
Summary of Scenario	976
Summary of Learning Objectives	976
Connections	977
43 Assisting with Diagnostic Imaging	978
Learning Objectives	978
Vocabulary	978
Scenario	978
Basic Principles of Radiography	980
Types of X-rays	982
Radiographic Equipment	982
Control Booth	982
Image Receptor Systems	982
Identification.	983
Technology in Radiography	983
Radiographic Table	983
X-ray Tubes	983
Collimator	984
Power Supply	984
X-ray Exposure	984
Prime Factors	984
Technique Charts.	984
Radiographic Positioning	985
Anatomic Locations	985
Body Planes	985
Positions	985
Radiographic Projections	986
Markers	987
Other Diagnostic Radiologic Testing	987
Fluoroscopy and X-ray Studies That Use Contrast Media	988
Fluoroscopy	988
X-ray Studies That Use Contrast Media	988
Cardiovascular and Interventional Radiography	989
Computed Tomography	990
Magnetic Resonance Imaging	991
Sonography	992
Nuclear Medicine	993
Dual Energy X-ray Absorptiometry	994
Basic Radiographic Procedure	994
Patient Preparation and Explanation	994
Scheduling and Sequencing Diagnostic Imaging Procedures	996
Sequencing Order for Diagnostic Studies	996
Radiation Safety	997
Radiation Units	997
Effects of Low-Dose Radiation Exposure	999
Cellular Response to Exposure.	999
Somatic Effects.	1000
Genetic Effects.	1000
Radiation and Pregnancy.	1000
Guidelines for Pediatric X-ray Examinations	1000
Radiation Protection	1000
Personnel Safety	1001
Pre-exposure Safety Check.	1001
Personnel Monitoring.	1001
Patient Protection	1002
Gonad Shielding.	1003
Pregnant or Possibly Pregnant Patients.	1003
Closing Comments	1004
Role of the Medical Assistant	1004
Patient Education	1004
Legal and Ethical Issues	1004
Summary of Scenario	1005
Summary of Learning Objectives	1006
Connections	1007
44 Assisting in the Clinical Laboratory	1008
Learning Objectives	1008
Vocabulary	1008
Scenario	1008
Role of the Clinical Laboratory in Patient Care	1009
Personnel in the Clinical Laboratory	1009
Clinical Laboratory Testing	1009
Divisions of the Clinical Laboratory	1010
Urinalysis	1010
Hematology	1011
Chemistry	1011
Microbiology	1011
Government Legislation Affecting Clinical Laboratory Testing	1011
Clinical Laboratory Improvement Amendments	1011
CLIA-Waived Tests and Laboratories	1012
Moderate- and High-Complexity Tests and Laboratories	1012
Quality Assurance Guidelines	1014
Quality Control Guidelines	1014
Laboratory Safety	1017
Safety Standards and Governing Agencies	1017
Chemical Hazards	1018
Biohazards and Infection Control	1019
Standard Precautions	1019
Bloodborne Pathogens Standard	1019
Physical Hazards	1020
Specimen Collection, Processing, and Storage	1020
Laboratory Requisitions and Reports	1020
Specimen Collection	1022
Preventing Contamination	1023
Handling, Processing, and Storage of Specimens	1023
Chain of Custody	1023
Steps in Collecting Specimens and Informing the Patient of the Results	1023
Laboratory Mathematics and Measurement	1024
Measuring Time	1024
Measuring Temperature	1024
Units of Measurement	1024
Measuring Liquid Volume	1025
Laboratory Equipment	1025
Microscope	1025
Centrifuge	1028
Incubator	1028
Closing Comments	1028
Patient Education	1028
Legal and Ethical Issues	1029
Summary of Scenario	1029
Summary of Learning Objectives	1030
Connections	1031
45 Assisting in the Analysis of Urine	1032
Learning Objectives	1032
Vocabulary	1032
Scenario	1032
History of the Analysis of Urine	1033
Anatomy and Physiology of the Urinary Tract	1033
Formation and Elimination of Urine	1033
Filtration	1033
Reabsorption	1034
Secretion	1034
Elimination	1034
Collecting a Urine Specimen	1034
Patient Sensitivity	1034
Containers	1035
Methods of Specimen Collection	1035
Handling and Transportation of a Specimen	1038
Routine Urinalysis	1039
Physical Examination of the Urine	1039
Appearance	1039
Color.	1039
Turbidity.	1040
Volume	1041
Foam	1041
Odor	1041
Specific Gravity	1042
Chemical Examination of Urine	1042
pH	1043
Glucose	1043
Ketones	1043
Protein	1043
Blood	1044
Bilirubin and Urobilinogen	1044
Nitrite	1044
Leukocyte Esterase	1044
Limitations of Reagent Strip Testing	1044
Quality Assurance and Quality Control in Urinalysis	1045
Microscopic Preparation and Examination of Urine Sediment	1048
Microscopic Preparation of Urine	1048
Microscopic Examination of Urine	1049
Casts	1049
Cells	1050
Crystals	1052
Miscellaneous Findings	1054
Interpretation of the Microscopic Examination	1055
Additional Tests Performed on Urine	1056
Clinitest	1056
Urine Pregnancy Testing	1057
Ovulation Testing	1059
Menopause Testing	1059
Urine Toxicology	1059
Adulteration Testing and Chain of Custody	1061
Alcohol Testing	1064
Closing Comments	1064
Patient Education	1064
Legal and Ethical Issues	1064
Summary of Scenario	1064
Summary of Learning Objectives	1064
Connections	1065
46 Assisting in Blood Collection	1066
Learning Objectives	1066
Vocabulary	1067
Scenario	1066
Venipuncture Equipment	1067
Personal Protective Equipment	1068
Tourniquets	1068
Antiseptics	1068
Evacuated Collection Tubes	1069
Tube Additives	1069
Order of Collection	1071
Types of Needles and Supplies Used in Phlebotomy	1072
Multisample Needles	1072
Needle Holders	1072
Syringes	1073
Winged Infusion Sets (Butterfly Needles)	1073
Needle Safety	1073
Postexposure Management of Needlesticks	1075
Routine Venipuncture	1075
Patient Preparation	1075
Preparing for the Venipuncture	1076
Performing the Venipuncture	1076
Completing the Venipuncture	1077
Problems Associated with Venipuncture	1085
Specimen Re-collection	1086
Capillary Puncture	1088
Equipment	1088
Skin Puncture Devices	1088
Collection Containers	1088
Routine Capillary Puncture	1089
Site Selection	1089
Patient Preparation	1089
Collecting the Specimen	1089
Specimen Handling	1089
Pediatric Phlebotomy	1093
Handling the Specimen after Collection	1094
Chain of Custody	1094
Closing Comments	1095
Patient Education	1095
Legal and Ethical Issues	1095
Summary of Scenario	1095
Summary of Learning Objectives	1096
Connections	1097
47 Assisting in the Analysis of Blood	1098
Learning Objectives	1098
Vocabulary	1099
Scenario	1098
Hematology	1099
Erythrocytes	1099
Leukocytes	1100
Granular Leukocytes	1100
Nongranular Leukocytes	1100
T Cells: Cell-Mediated Immunity.	1100
B Cells: Humoral Immunity (Antibody-Mediated).	1100
Thrombocytes	1100
Clot Formation	1100
Plasma	1101
Hematology in the Physician Office Laboratory (POL)	1101
Hematocrit	1101
Hemoglobin	1105
Erythrocyte Sedimentation Rate	1107
Coagulation Testing	1109
Hematology in the Reference Laboratory	1111
CBC Laboratory Reports	1112
Red Blood Cell Count	1112
Red Cell Indices	1114
White Blood Cell Count	1114
Differential Cell Count	1114
Preparation of Blood Smears for the Differential	1114
Staining of Blood Smears	1115
Identification of Normal Blood Cells	1115
Differential Examination	1116
Red Blood Cell Morphology	1117
Size	1117
Shape	1117
Content	1117
Platelet Analysis	1117
Immunohematology-Blood Bank	1117
Blood Grouping	1117
Determination of ABO Blood Group	1118
Determination of Rh Factor	1118
Other Blood Types	1118
Legal and Ethical Issues Related to Blood Transfusions	1119
Blood Chemistry in the Physician Office Laboratory (POL)	1119
Blood Glucose Testing	1119
Hemoglobin A1c Testing	1119
Cholesterol Testing	1120
Alanine Aminotransferase (ALT) and Aspartate Aminotransferase (AST) Testing	1123
Thyroid Hormone Testing	1123
Reference Laboratory Chemistry Panels and Single Analyte Testing and Monitoring	1123
Closing Comments	1123
Patient Education	1123
Legal and Ethical Issues	1123
Summary of Scenario	1127
Summary of Learning Objectives	1127
Connections	1129
48 Assisting in Microbiology and Immunology	1130
Learning Objectives	1130
Vocabulary	1131
Scenario	1130
Classification of Microorganisms	1132
Naming of Microorganisms	1132
Typical Pathogenic Bacteria	1132
Bacterial Staining Characteristics	1132
Bacterial Shapes	1132
Bacterial Oxygen Requirements	1133
Bacterial Physical Structures	1134
Unusual Pathogenic Bacteria: Chlamydiae, Mycoplasmas, and Rickettsiae	1137
Pathogenic Fungi	1137
Pathogenic Protozoa	1138
Pathogenic Parasites	1138
Helminths (Worms)	1139
Pathogenic Viruses	1140
Specimen Collection and Transport in the POL	1142
Collection for the Pinworm Parasite	1145
CLIA-Waived Microbiology Tests	1145
Rapid Strep Testing	1146
Influenza A and B Testing	1147
Respiratory Syncytial Virus (RSV) Testing	1147
CLIA-Waived Immunology Testing	1148
Infectious Mononucleosis Testing	1148
Helicobacter pylori Antibody Testing	1150
Lyme Disease Antibody Testing	1150
HIV Antibody Testing	1151
Microbiology Reference Laboratory	1151
Identification of Pathogens in the Microbiology Laboratory	1151
Staining	1151
Gram’s Stain	1152
Acid-Fast Stain	1152
Inoculating Equipment	1152
Assessing a Culture	1153
Throat Culture	1153
Urine Cultures	1153
Microbiology Culture and Sensitivity Testing	1153
Closing Comments	1154
Patient Education	1154
Legal and Ethical Issues	1154
Summary of Scenario	1155
Summary of Learning Objectives	1156
Connections	1157
Unit Nine Assisting with Surgeries	1158
49 Surgical Supplies and Instruments	1158
Learning Objectives	1158
Vocabulary	1158
Scenario	1158
Minor Surgery Room	1159
Surgical Solutions and Medications	1159
Surgical Instruments	1160
Classifications of Surgical Instruments	1162
Cutting and Dissecting Instruments	1162
Bandage Scissors (Figure 49-5, A)	1162
Operating (Surgical) Scissors	1162
Metzenbaum (Metz) Scissors (Figure 49-5, B)	1162
Mayo Scissors (Figure 49-5, C and D)	1162
Iris Scissors (Figure 49-5, E and F)	1162
Littauer Stitch or Suture Scissors (Figure 49-6)	1162
Disposable Scalpels (Figure 49-7)	1162
Grasping and Clamping Instruments	1163
Hemostat Forceps (Figure 49-8, A and B)	1163
Needle Holders (Figure 49-8, C and D)	1163
Splinter Forceps	1163
Adson Forceps (Figure 49-9)	1163
Plain Thumb (Dressing) Forceps (Figure 49-10)	1163
Towel Forceps (Towel Clamp) (Figure 49-11)	1163
Allis Tissue Forceps (Figure 49-12, A)	1164
Foerster Sponge Forceps (Figure 49-12, B)	1164
Transfer Forceps (Figure 49-12, C to E)	1164
Adson Thumb Forceps (Figure 49-13, A and B)	1164
Bayonet Forceps (Figure 49-13, C to E)	1164
Plain-Tip Tissue Forceps (Figure 49-13, F)	1164
Toothed Tissue Forceps (Figure 49-13, G)	1164
Retractors	1164
Senn Retractor (Figure 49-14)	1164
Probes and Dilators	1164
Probes (Figure 49-15, A to C)	1164
Trocars and Obturators (Figure 49-15, D to G)	1166
Specula (Figure 49-16)	1166
Nasal Specula (see Figure 49-16, A and B)	1167
Specialty Instruments	1167
Gynecologic Instruments	1167
Foerster Sponge Forceps (Figure 49-17, A)	1167
Placenta Forceps (Figure 49-17, B)	1167
Bozeman Uterine Dressing Forceps (Figure 49-17, C)	1167
Endocervical Curette (Figure 49-17, D)	1167
Sims Uterine Curette (Figure 49-17, E)	1167
Schroeder Uterine Vulsellum Forceps (Figure 49-17, F)	1167
Long Allis Forceps (Figure 49-17, G)	1167
Schroeder Uterine Tenaculum Forceps (Figure 49-17, H)	1167
Hegar Uterine Dilators (Figure 49-18, A)	1167
Sims Uterine Sounds (Figure 49-18, B)	1167
Ophthalmologic and Otolaryngologic Instruments	1167
Krause Nasal Snare (Figure 49-19, A)	1167
Metal Tongue Depressor (Figure 49-19, B)	1167
Hartmann “Alligator” Ear Forceps (Figure 49-19, C)	1168
Laryngeal Mirror (Figure 49-19, D)	1168
Ivan Laryngeal Metal Applicator (Figure 49-19, E)	1168
“Buck” Ear Curette (Figure 49-19, F)	1168
Sharp Ear Dissector (Figure 49-19, G)	1168
Biopsy Instruments	1168
Cervical Biopsy Forceps (Figure 49-20, A)	1168
Rectal Biopsy Punch (Figure 49-20, B)	1168
Silverman Biopsy Needle	1168
Genitourinary Instruments	1168
Foley Catheter with Inflated Balloon (Figure 49-21, A)	1168
Red Robinson Catheter (Figure 49-21, B)	1169
Coudé-Tip Catheter	1169
12-mL Luer-Lok Syringe (Figure 49-21, C)	1169
Care and Handling of Instruments	1169
Drapes, Sutures, and Needles	1170
Sutures	1170
Absorbable Sutures	1171
Nonabsorbable Sutures and Other Closure Materials	1171
Suture Sizing and Packaging	1172
Needles	1173
Closing Comments	1173
Patient Education	1173
Legal and Ethical Issues	1173
Summary of Scenario	1173
Summary of Learning Objectives	1174
Connections	1174
50 Surgical Asepsis and Assisting With Surgical Procedures	1175
Learning Objectives	1175
Vocabulary	1176
Scenario	1175
Sterilization	1176
Autoclave	1177
Wrapping Materials	1177
Wrapping Instruments	1181
Sterilization Indicators	1181
Chemical Sterilization Indicators.	1181
Biologic Sterilization Indicators.	1181
Quality-Assurance Records for Office Sterilization	1182
Loading the Autoclave	1182
Unloading Guidelines	1182
Shelf Life of Sterilized Packs.	1183
Chemical Sterilization	1183
Surgical Procedures	1183
Electrosurgery	1183
Laser Surgery	1184
Microsurgery	1184
Endoscopic Procedures	1184
Cryosurgery	1185
Assisting with Surgical Procedures	1185
Preparation of the Patient	1185
Preoperative Instructions	1185
Informed Consent	1186
Positioning	1186
Skin Preparation	1186
Preparation of the Room	1187
Sterile Technique	1188
Sterile Field	1195
Assisting the Physician during Surgery	1196
Passing Instruments	1199
Specimen Collection	1199
Completing the Surgical Procedure	1199
Postoperative Responsibilities	1202
Postoperative Instructions and Care	1203
Warning Signs	1203
Follow-Up	1203
Wound Care	1204
Wound Healing	1205
Dressings	1207
Bandages	1207
Closing Comments	1210
Patient Education	1210
Legal and Ethical Issues	1211
Summary of Scenario	1211
Summary of Learning Objectives	1212
Connections	1213
Unit Ten Career Development	1214
51 Career Development and Life Skills	1214
Learning Objectives	1214
Vocabulary	1215
Scenario	1214
Moving on to the Next Phase of Life	1215
Understanding Personality Traits Important to Employers	1215
Assessing Your Strengths and Skills	1216
Developing Career Objectives	1217
Knowing Personal Needs	1217
Finding a Job	1218
Two Best Job Search Methods	1218
Traditional Job Search Methods	1219
School Career Placement Offices	1219
Newspaper Ads	1219
Employment Agencies	1219
Improving Your Opportunities	1219
Being Organized in Your Job Search	1220
Developing a Résumé	1220
Résumé Formats	1221
Résumé Content	1222
Header	1222
Objective	1223
Education	1223
Work Experience	1223
Summary and Skills	1225
Special Skills	1225
Certifications	1225
Appearance of the Résumé	1225
Developing a Cover Letter	1226
Completing Online Profiles and Job Applications	1228
Creating a Career Portfolio	1230
Job Interview	1231
Preparation for the Interview	1231
During the Interview	1233
Phone Interview	1233
Face-to-Face Interview	1233
Video Interview	1234
Follow-Up After the Interview	1235
Reasons People Do Not Get Hired	1236
Negotiation	1236
You Got the Job!	1236
Common Early Mistakes	1236
Being a Good Employee	1236
Dealing With Supervisors	1237
Performance Appraisals	1237
Pursuing a Raise	1237
Leaving a Job	1238
Life Skills	1238
Personal Growth	1238
Steps for Achieving Goals	1238
Self-Control	1238
Self-Esteem	1238
Problem-Solving Skills	1238
Decision-Making Skills	1239
Professional Development	1239
Stress Management	1239
Closing Comments	1240
Legal and Ethical Issues	1240
Summary of Scenario	1240
Summary of Learning Objectives	1241
Connections	1242
Glossary	1243
Index	1260
A	1260
B	1261
C	1262
D	1265
E	1267
F	1268
G	1269
H	1270
I	1271
J	1272
K	1273
L	1273
M	1274
N	1275
O	1276
P	1277
Q	1280
R	1280
S	1281
T	1283
U	1284
V	1285
W	1285
X	1285
Y	1285
Z	1285

Kinn's The Medical Assistant

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