Diversified Health Occupations 7 Book Part 1

DIVERSIFIED
HEALTH
OCCUPATIONS
Seventh Edition
Louise Simmers, MEd, RN

Karen Simmers-Nartker, BSN, RN
Sharon Simmers-Kobelak, BBA
Australia • Brazil • Japan • Korea • Mexico • Singapore • Spain • United Kingdom • United States
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Diversified Health Occupations, Seventh © 2009 Delmar, Cengage Learning
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Louise Simmers
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Karen Simmers-Nartker
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Printed in Canada
1 2 3 4 5 6 7 12 11 10 09 08
CONTENTS
Preface xi
How to Use xvii
Acknowledgments xxv
PART 1
Basic Health Care Concepts and Skills 1
CHAPTER 1 History and Trends of Health Care 2
Objectives 2 Today’s Research: Tomorrow’s Health Care 24
Key Terms 3 Summary 25
1:1 History of Health Care 3 Internet Searches 25
1:2 Trends in Health Care 14 Review Questions 25
CHAPTER 2 Health Care Systems 26

Objectives 26 2:5 Organizational Structure 35
Key Terms 27 Today’s Research: Tomorrow’s Health Care 36
2:1 Private Health Care Facilities 27 Summary 37
2:2 Government Agencies 31 Internet Searches 37
2:3 Voluntary or Nonprofit Agencies 32 Review Questions 37
2:4 Health Insurance Plans 32
CHAPTER 3 Careers in Health Care 38

Objectives 38 3:2F Nursing Careers 55
Key Terms 39 3:2G Nutrition and Dietary Services
3:1 Introduction to Health Careers 40 Careers 57
3:2 Therapeutic Services Careers 46 3:2H Veterinary Careers 58
3:2A Dental Careers 46 3:2I Vision Services Careers 60
3:2B Emergency Medical Services 3:2J Other Therapeutic Services Careers 61
Careers 48 3:3 Diagnostic Services Careers 67
3:2C Medical Careers 50 3:4 Health Informatics Careers 72
3:2D Mental and Social Services Careers 52 3:5 Support Services Careers 76
3:2E Mortuary Careers 54
iv CONTENTS
3:6 Biotechnology Research Summary 80

and Development Careers 77 Internet Searches 80
Today’s Research: Tomorrow’s Health Care 79 Review Questions 80
CHAPTER 4 Personal and Professional Qualities

of a Health Care Worker 81
Objectives 81 4:6 Stress 95
Key Terms 82 4:7 Time Management 97
4:1 Personal Appearance 82 Today’s Research: Tomorrow’s Health Care 100
4:2 Personal Characteristics 85 Summary 100
4:3 Effective Communications 86 Internet Searches 101
4:4 Teamwork 92 Review Questions 101
4:5 Professional Leadership 94
CHAPTER 5 Legal and Ethical Responsibilities 103

Objectives 103 5:5 Professional Standards 115
5:1 Legal Responsibilities 104 Summary 117
5:2 Ethics 111 Internet Searches 118
5:3 Patients’ Rights 112 Review Questions 118
5:4 Advance Directives for Health Care 113
CHAPTER 6 Medical Terminology 119

6:1 Using Medical Abbreviations 120 Internet Searches 139
6:2 Interpreting Word Parts 127 Review Questions 139
CHAPTER 7 Anatomy and Physiology 140

Objectives 140 7:9 Lymphatic System 194
Key Terms 141 7:10 Respiratory System 197
7:1 Basic Structure of the Human Body 141 7:11 Digestive System 203
7:2 Body Planes, Directions, and Cavities 148 7:12 Urinary System 210
7:3 Integumentary System 151 7:13 Endocrine System 216
7:4 Skeletal System 156 7:14 Reproductive System 223
7:5 Muscular System 163 Today’s Research: Tomorrow’s Health Care 232
7:6 Nervous System 168 Summary 233
7:7 Special Senses 176 Internet Searches 233
7:8 Circulatory System 183 Review Questions 233
CHAPTER 8 Human Growth and Development 235

8:1 Life Stages 236 Internet Searches 256
8:2 Death and Dying 247 Review Questions 256
8:3 Human Needs 250
Contents v
CHAPTER 9 Cultural Diversity 257

Objectives 257 9:4 Respecting Cultural Diversity 272
9:1 Culture, Ethnicity, and Race 258 Today’s Research: Tomorrow’s Health Care 273
9:2 Bias, Prejudice, and Stereotyping 260 Internet Searches 273
9:3 Understanding Cultural Diversity 261 Review Questions 274
CHAPTER 10 Geriatric Care 275

Objectives 275 10:5 Meeting the Needs of the Elderly 291
10:1 Myths on Aging 276 Today’s Research: Tomorrow’s Health Care 293
10:2 Physical Changes of Aging 278 Internet Searches 293
10:3 Psychosocial Changes of Aging 284 Review Questions 294
10:4 Confusion and Disorientation
in the Elderly 287
CHAPTER 11 Nutrition and Diets 295

Objectives 295 11:5 Weight Management 305
Key Terms 296 11:6 Therapeutic Diets 309
11:1 Fundamentals of Nutrition 296 Today’s Research: Tomorrow’s Health Care 312
11:2 Essential Nutrients 297 Summary 312
11:3 Utilization of Nutrients 301 Internet Searches 313
11:4 Maintenance of Good Nutrition 302 Review Questions 13
CHAPTER 12 Computer Technology in Health Care 314

Objectives 314 12:5 Computer Protection and Security 329
12:1 Introduction 315 Summary 331
12:2 What Is a Computer System? 316 Internet Searches 331
12:3 Computer Applications 319 Review Questions 331
12:4 Using the Internet 326
CHAPTER 13 Promotion of Safety 333

13:1 Using Body Mechanics 334 Internet Searches 348
13:2 Preventing Accidents and Injuries 336 Review Questions 349
13:3 Observing Fire Safety 343
vi CONTENTS
CHAPTER 14 Infection Control 350

Objectives 350 C: Donning and Removing Sterile
Key Terms 351 Gloves 392
14:1 Understanding the Principles D: Changing a Sterile Dressing 395
of Infection Control 351 14:9 Maintaining Transmission-Based
14:2 Bioterrorism 357 Isolation Precautions 397
14:3 Washing Hands 359 A: Donning and Removing
14:4 Observing Standard Precautions 363 Transmission-Based Isolation
14:5 Sterilizing with an Autoclave 371 Garments 402
A: Wrapping Items for Autoclaving 373 B: Working in a Hospital
B: Loading and Operating Transmission-Based Isolation Unit 406
an Autoclave 377 Summary 409
14:6 Using Chemicals for Disinfection 379 Today’s Research: Tomorrow’s Health Care 410
14:7 Cleaning with an Ultrasonic Unit 381 Internet Searches 411
14:8 Using Sterile Techniques 385 Review Questions 411
A: Opening Sterile Packages 386
B: Preparing a Sterile Dressing Tray 389
CHAPTER 15 Vital Signs 412

Objectives 412 G: Measuring and Recording Temporal
Key Terms 413 Temperature 430
15:1 Measuring and Recording Vital Signs 413 15:3 Measuring and Recording Pulse 431
15:2 Measuring and Recording Temperature 414 15:4 Measuring and Recording Respirations 433
A: Cleaning a Clinical Thermometer 419 15:5 Graphing TPR 435
B: Measuring and Recording Oral 15:6 Measuring and Recording Apical Pulse 438
Temperature 421 15:7 Measuring and Recording Blood
C: Measuring and Recording Rectal Pressure 440
Temperature 423 Today’s Research: Tomorrow’s Health Care 446
D: Measuring and Recording Axillary Summary 446
Temperature 424 Internet Searches 446
E: Measuring and Recording Tympanic Review Questions 447
(Aural) Temperature 426
F: Measuring Temperature with an
Electronic Thermometer 428
CHAPTER 16 First Aid 448

Objectives 448 F: Performing CPR—Obstructed
Key Terms 449 Airway on Conscious Infant 471
16:1 Providing First Aid 449 16:3 Providing First Aid for Bleeding and
16:2 Performing Cardiopulmonary Wounds 473
Resuscitation 452 16:4 Providing First Aid for Shock 479
A: Performing CPR—One-Person 16:5 Providing First Aid for Poisoning 483
Adult Rescue 458 16:6 Providing First Aid for Burns 488
B: Performing CPR—Two-Person 16:7 Providing First Aid for Heat Exposure 493
Adult Rescue 462 16:8 Providing First Aid for Cold Exposure 496
C: Performing CPR on Infants 464 16:9 Providing First Aid for Bone and Joint
D: Performing CPR on Children 467 Injuries 498
E: Performing CPR—Obstructed 16:10 Providing First Aid for Specific Injuries 505
Airway on Conscious Adult or Child 469 16:11 Providing First Aid for Sudden Illness 513
Contents vii
16:12 Applying Dressings and Bandages 519 Internet Searches 526

Summary 525 Review Questions 526
Today’s Research: Tomorrow’s Health Care 526
CHAPTER 17 Preparing for the World of Work 528

Objectives 528 17:5 Determining Net Income 543
Key Terms 529 17:6 Calculating a Budget 545
17:1 Developing Job-Keeping Skills 529 Summary 547
17:2 Writing a Cover Letter and Preparing Today’s Research: Tomorrow’s Health Care 548
a Résumé 530 Internet Searches 548
17:3 Completing Job Application Forms 537 Review Questions 549
17:4 Participating in a Job Interview 539
PART 2
Special Health Care Skills 550
CHAPTER 18 Dental Assistant Skills 552
Objectives 552 A: Preparing Alginate 602
Key Terms 553 B: Preparing Rubber Base (Polysulfide) 605
Career Highlights 554 C: Pouring a Plaster Model 608
18:1 Identifying the Structures and Tissues D: Pouring a Stone Model 612
of a Tooth 554 E: Trimming a Model 613
18:2 Identifying the Teeth 558 18:11 Making Custom Trays 615
18:3 Identifying Teeth Using the Universal/ 18:12 Maintaining and Loading an
National Numbering System and the Anesthetic Aspirating Syringe 618
Federation Dentaire International (FDI) A: Maintaining an Anesthetic
System 560 Aspirating Syringe 621
A: Identifying Teeth Using the B: Loading an Anesthetic Aspirating
Universal/National Numbering Syringe 622
System 563 18:13 Mixing Dental Cements and Bases 624
B: Identifying Teeth Using the A: Preparing Varnish 626
Federation Dentaire International B: Preparing Calcium Hydroxide 627
(FDI) Numbering System 564 C: Preparing Polycarboxylate 629
18:4 Identifying the Surfaces of the D: Preparing Zinc Oxide Eugenol (ZOE) 630
Teeth 565 18:14 Preparing Restorative Materials—
18:5 Charting Conditions of the Teeth 568 Amalgam and Composite 632
18:6 Operating and Maintaining Dental A: Preparing Amalgam 635
Equipment 574 B: Preparing Composite 637
18:7 Identifying Dental Instruments and 18:15 Developing and Mounting Dental
Preparing Dental Trays 584 Radiographs (X-Rays) 639
18:8 Positioning a Patient in the Dental A: Developing Dental Radiographs
Chair 592 (X-Rays) 642
18:9 Demonstrating Brushing and Flossing B: Mounting Dental Radiographs
Techniques 594 (X-Rays) 644
A: Demonstrating Brushing Technique 595 Today’s Research: Tomorrow’s Health Care 646
B: Demonstrating Flossing Technique 597 Summary 646
18:10 Taking Impressions and Pouring Internet Searches 647
Models 598 Review Questions 647
viii CONTENTS
CHAPTER 19 Laboratory Assistant Skills 648

Objectives 648 19:6 Preparing and Staining a Blood Film
Key Terms 649 or Smear 682
Career Highlights 649 A: Preparing a Blood Film or Smear 684
19:1 Operating the Microscope 650 B: Staining a Blood Film or Smear 685
19:2 Obtaining and Handling Cultures 656 19:7 Testing for Blood Types 687
A: Obtaining a Culture Specimen 658 19:8 Performing an Erythrocyte
B: Preparing a Direct Smear 660 Sedimentation Rate 691
C: Streaking an Agar Plate 662 19:9 Measuring Blood-Sugar (Glucose)
D: Transferring Culture from Agar Level 695
Plate to Slide 664 19:10 Testing Urine 699
E: Staining with Gram’s Stain 666 19:11 Using Reagent Strips to Test Urine 701
19:3 Puncturing the Skin to Obtain 19:12 Measuring Specific Gravity 705
Capillary Blood 668 19:13 Preparing Urine for Microscopic
19:4 Performing a Microhematocrit 671 Examination 709
19:5 Measuring Hemoglobin 676 Today’s Research: Tomorrow’s Health Care 713
A: Measuring Hemoglobin with a Summary 713
Hemoglobinometer 677 Internet Searches 714
B: Measuring Hemoglobin with a Review Questions 714
Photometer 680
CHAPTER 20 Medical Assistant Skills 715

Objectives 715 20:5 Assisting with Minor Surgery
Key Terms 716 and Suture Removal 748
Career Highlights 716 A: Assisting with Minor Surgery 751
20:1 Measuring/Recording Height B: Assisting with Suture Removal 755
and Weight 717 20:6 Recording and Mounting an
A: Measuring/Recording Height Electrocardiogram 756
and Weight 721 20:7 Using the Physicians’ Desk Reference
B: Measuring/Recording Height (PDR) 768
and Weight of an Infant 723 20:8 Working with Math and Medications 770
20:2 Positioning a Patient 725 A: Using Roman Numerals 773
20:3 Screening for Vision Problems 732 B: Converting Metric Measurements 774
20:4 Assisting with Physical Examinations 737 C: Converting Household (English)
A: Eye, Ear, Nose, and Throat Measurements 775
Examination 741 Today’s Research: Tomorrow’s Health Care 776
B: Assisting with a Gynecological Summary 777
Examination 743 Internet Searches 777
C: Assisting with a General Physical Review Questions 777
Examination 745
Contents ix
CHAPTER 21 Nurse Assistant Skills 779

Objectives 779 21:6 Feeding a Patient 855
Key Terms 780 21:7 Assisting with a Bedpan/Urinal 859
Career Highlights 781 A: Assisting with a Bedpan 860
21:1 Admitting, Transferring, B: Assisting with a Urinal 863
and Discharging Patients 782 21:8 Providing Catheter and Urinary
A: Admitting the Patient 784 Drainage Unit Care 864
B: Transferring the Patient 786 A: Providing Catheter Care 868
C: Discharging the Patient 788 B: Emptying a Urinary-Drainage Unit 870
21:2 Positioning, Turning, Moving, 21:9 Providing Ostomy Care 872
and Transferring Patients 790 21:10 Collecting Stool/Urine Specimens 877
A: Aligning the Patient 793 A: Collecting a Routine Urine
B: Moving the Patient Up in Bed 795 Specimen 880
C: Turning the Patient Away B: Collecting a Midstream Urine
to Change Position 797 Specimen 882
D: Turning the Patient Inward C: Collecting a 24-Hour Urine
to Change Position 799 Specimen 884
E: Sitting Up to Dangle 801 D: Collecting a Stool Specimen 886
F: Transferring a Patient to a Chair E: Preparing and Testing a Hemoccult
or Wheelchair 803 Slide 887
G: Transferring a Patient to a Stretcher 806 21:11 Enemas and Rectal Treatments 889
H: Using a Mechanical Lift to Transfer A: Giving a Tap-Water, Normal Saline,
a Patient 809 or Soap-Solution Enema 890
21:3 Bedmaking 812 B: Giving a Disposable Enema 894
A: Making a Closed Bed 813 C: Giving an Oil-Retention Enema 896
B: Making an Occupied Bed 817 D: Inserting a Rectal Tube 898
C: Opening a Closed Bed 820 21:12 Applying Restraints 900
D: Placing a Bed Cradle 821 A: Applying Limb Restraints 902
21:4 Administering Personal Hygiene 823 B: Applying a Jacket Restraint 904
A: Providing Routine Oral Hygiene 827 21:13 Administering Preoperative and
B: Cleaning Dentures 828 Postoperative Care 906
C: Giving Special Mouth Care 830 A: Shaving the Operative Area 910
D: Administering Daily Hair Care 832 B: Administering Preoperative Care 912
E: Providing Nail Care 834 C: Preparing a Postoperative Unit 913
F: Giving a Backrub 835 D: Applying Surgical Hose 915
G: Shaving a Patient 838 21:14 Applying Binders 917
H: Changing a Patient’s Gown or 21:15 Administering Oxygen 919
Pajamas 840 21:16 Giving Postmortem Care 925
I: Giving a Complete Bed Bath 842 Today’s Research: Tomorrow’s Health Care 928
J: Helping a Patient Take a Tub Bath Summary 928
or Shower 847 Internet Searches 929
21:5 Measuring and Recording Intake Review Questions 929
and Output 849
x CONTENTS
CHAPTER 22 Physical Therapy Skills 930

Objectives 930 D: Ambulating a Patient Who Uses
Key Terms 931 a Walker 953
Career Highlights 931 22:3 Administering Heat/Cold Applications 954
22:1 Performing Range-of-Motion (ROM) A: Applying an Ice Bag or Ice Collar 957
Exercises 932 B: Applying a Warm-Water Bag 959
22:2 Ambulating Patients Who Use Transfer C: Applying a Aquathermia Pad 961
(Gait) Belts, Crutches, Canes, D: Applying a Moist Compress 963
or Walkers 940 E: Administering a Sitz Bath 965
A: Ambulating a Patient with Today’s Research: Tomorrow’s Health Care 967
a Transfer (Gait) Belt 945 Summary 967
B: Ambulating a Patient Who Uses Internet Searches 967
Crutches 947 Review Questions 968
C: Ambulating a Patient Who Uses
a Cane 950
CHAPTER 23 Business and Accounting Skills 969

23:1 A: Filing Records 970 Internet Searches 1020
23:1 B: Filing Records Using the Review Questions 1021
Alphabetical or Numerical System 973
23:2 Using the Telephone 977
Appendix A: Career and Technical Student
23:3 Scheduling Appointments 983
Organizations (CTSOs) 1022
23:4 Completing Medical Records
and Forms 987 Appendix B: Correlation to National
23:5 Composing Business Letters 993 Health Care Skill Standards 1026
23:6 Completing Insurance Forms 999 Appendix C: Metric Conversion Charts 1027
23:7 Maintaining a Bookkeeping System 1007 Appendix D: 24-Hour Clock (Military Time)
23:8 Writing Checks, Deposit Slips, Conversion Chart 1029
and Receipts 1013
Glossary 1030
A: Writing Checks 1015
B: Writing Deposit Slips 1017 References 1052
C: Writing Receipts 1018 Index 1060
PREFACE
Diversified Health Occupations, seventh edition, was written to pro-

vide the beginning student in health occupations with the basic
entry-level knowledge and skills required for a variety of health care
careers. Although each specific health care career requires special-
ized knowledge and skills, some knowledge and skills are applicable
to many different health careers. In short, this book was developed
to provide some of the core knowledge and skills that can be used in
many different fields.
ORGANIZATION OF TEXT
Diversified Health Occupations, seventh edition, is divided into two
main parts. Part 1 provides the student with the basic knowledge and
skills required for many different health care careers. Part 2 intro-
duces the student to basic entry-level skills required for some spe-
cific health care careers. Each part is subdivided into chapters.
Chapter Organization
Each chapter has a list of objectives and a list of key terms (with
pronunciations for more difficult words). For each skill included in
the text, both the knowledge necessary for the skill and the proce-
dure to perform the skill are provided. By understanding the princi-
ples and the procedure, the student will develop a deeper
understanding of why certain things are done and will be able to
perform more competently. Procedures may vary slightly depending
on the type of agency and on the kind of equipment and supplies
used. By understanding the underlying principles, however, the stu-
dent can adapt the procedure as necessary and still observe correct
technique.
Information Sections (Textbook): The information sections provide
the basic knowledge the student must acquire. These sections explain
why the knowledge is important, the basic facts regarding the par-
ticular topic, and how this information is applied in various health
careers. Most information sections refer the student to the assign-
ment sheets found in the student workbook.
xii PREFACE
Assignment Sheets (Workbook): After students ♦ The text material covers the National Health
have read an information section, they are Care Skills Standards, helping instructors
instructed to go to the corresponding assignment implement the curriculum elements of this
sheet. The assignment sheets allow them to test important document. A new appendix pro-
their comprehension and to return to the infor- vides a table showing the correlation of chap-
mation section to check their answers. This ters in the book to the National Health Care
enables them to reinforce their understanding of Skill Standards.
the information presented prior to moving on to
another information section.
♦ Mandates of the Health Insurance Portability
and Accountability Act (HIPAA) have been
Procedure Sections (Textbook): The procedure
incorporated throughout the textbook to
sections provide step-by-step instructions on how
emphasize the student’s responsibilities in
to perform specific procedures. The student follows
regard to this act.
the steps while practicing the procedures. Each
procedure begins with a list of the necessary equip- ♦ Internet search topics are at the end of each
ment and supplies. Note, Caution, and Checkpoint chapter to encourage the student to explore
may appear within the procedure. Note urges care- the Internet to obtain current information on
ful reading of the comments that follow. These com- the many aspects of health care.
ments usually stress points of knowledge or explain ♦ Review questions are at the end of each chapter
why certain techniques are used. Caution indicates to enable the student to test his or her knowl-
that a safety factor is involved and that students edge of information provided in the chapter.
should proceed carefully while doing the step in
♦ Career information has been updated and is
order to avoid injuring themselves or a patient.
stressed throughout the textbook to provide
Checkpoint alerts students to ask the instructor to
current information on a wide variety of health
check their work at that point in the procedure.
care careers. Careers have been organized
Checkpoints are usually located at a critical stage.
according to the National Career Clusters. In
Each procedure section refers the student to a spe-
addition, careers in forensic medicine and
cific evaluation sheet in the workbook.
biotechnology have been added.
Evaluation Sheets (Workbook): Each evaluation
sheet contains a list of criteria on which the stu- ♦ Additional emphasis has been placed on cul-
dent’s performance will be tested after they have tural diversity, technological advances, legal
mastered a particular procedure. When a student responsibilities, new federal legislation per-
feels he or she has mastered a particular proce- taining to health care providers, infection con-
dure, he or she signs the evaluation sheet and trol standards, and safety.
gives it to the instructor. The instructor can grade ♦ Various icons have been included throughout
the students’ performance by using the listed cri- the textbook. These icons denote the integra-
teria and checking each step against actual per- tion of academics, such as math, science, and
formance. communication; occupational safety issues,
Because regulations vary from state to state such as standard precautions and OBRA re-
regarding which procedures can be per- quirements; and workplace readiness issues
formed by a student in health science technology such as career, legal, and technology informa-
education, it is important to check the specific tion. An icon key similar to the one below can
regulations for your state. A health care worker be found on the opening page of every chapter.
should never perform any procedure without The icons and their meaning are as follows:
checking legal responsibilities. In addition, a stu-
Observe Standard Precautions
dent should perform no procedure unless the
student has been properly taught the procedure
Safety—Proceed with Caution
and has been authorized to perform it.
Math Skill
Added Features
Science Skill
♦ More than 240 new photos and illustrations
have been added to enhance learning and
Communications Skill
clarify technical content.
Preface xiii
Instructor’s Check—Call Instructor at This and safeguards that must be taken to protect
Point computer security.
OBRA Requirement—Based on Federal Law ♦ A free StudyWARE™ CD-ROM is packaged

with the book. The software is designed to
Legal Responsibility offer additional review of concepts. See “How
to Use the Diversified Health Occupations,
Career Information Seventh Edition, StudyWARE™” for details.
Technology
EXTENSIVE TEACHING
AND LEARNING
Enhanced Content PACKAGE
Diversified Health Occupations, seventh edition,
♦ Vital, updated information on standard pre-
has a complete and specially designed supple-
cautions, OBRA requirements, and transmis-
ment package to enhance student learning and
sion-based isolation techniques have been
workplace preparation. It is also designed to
included.
assist instructors in planning and implementing
♦ A new section on bioterrorism provides infor- their instructional programs for the most effi-
mation to make students aware of this con- cient use of time and resources. The package
stant threat and to describe methods used to contains:
prevent and manage its consequences.
♦ The information on viruses has been expanded
to include new viruses that can become po- Diversified Health Occupations
tential sources of epidemics and pandemics. Teacher’s Resource Kit
New emphasis is placed on infection con-
trol methods to prevent epidemics and/or A complete guide to implementing a Diversified
pandemics. Health Occupations course. The kit explains how
to apply content to applied academics and the
♦ The section on cardiopulmonary resuscita- National Health Care Skill Standards. This kit is
tion has been revised to meet the American provided as a three-ring binder with convenient
Heart Association’s new 2005 standards for tabs to easily locate the resources needed for spe-
CPR for health care professionals. cific classroom support. It provides:
♦ New nutritional guidelines from the U.S. ♦ Classroom Management Activities
Department of Agriculture have been incor-
porated into the nutrition chapter. Instruc- ♦ Lesson Plans
tions are provided for using My Pyramid to ♦ Ready-to-Use Tests and Quizzes
plan a healthy diet.
♦ Classroom Activities
♦ A new section on weight management dis-
cusses how to calculate ideal weight, how to ♦ Internet Activities
lose or gain weight, and how to make food ♦ Leadership Development Activities
choices that will maintain a healthy weight.
♦ Transparency Masters to reinforce learning in
♦ Mandates of the Health Insurance Portability a visual format
and Accountability Act (HIPAA) have been
incorporated throughout the textbook to
emphasize how it affects insurance portability Diversified Health
and confidentiality of patient information.
Occupations, Seventh Edition,
♦ A new section on Internet computer safety
and security explains ways to protect com-
Instructor’s Manual
puter hardware and software, methods used Provides easy-to-find answers to questions found
to maintain confidentiality of information, in the Student Workbook.
xiv PREFACE
Diversified Health WebTutor to Accompany

Occupations, Seventh Edition, Diversified Health
Student Workbook Occupations, Seventh Edition
This workbook, updated to reflect the Diversified WebTutor is an Internet-based course manage-
Health Occupations, seventh edition text, con- ment and delivery system designed to accom-
tains perforated, performance-based assignment pany the text. Its content is available for use in
and evaluation sheets. The assignment sheets either WebCT or Blackboard. Available to supple-
help students review what they have learned. The ment on-site delivery or as the course manage-
evaluation sheets provide criteria or standards ment platform for an online course, WebTutor
for judging student performance for each proce- contains:
dure in the text.
♦ Web links that offer links to other sites that
contain additional information pertinent to
Diversified Health Occupations topics being discussed
Electronic Classroom Manager ♦ Learning links that offer students a short

assignment using the Internet
An electronic package for teachers, this innova-
tive CD-ROM provides a wealth of tools to sup- ♦ Flashcards for review of key terms
port and manage the course. Components ♦ Online quizzes for each chapter
include:
♦ Plus a host of other great features
♦ Customizable Computerized Test Bank on the
ExamView platform providing over 1,800 ques-
tions and answers directly tied to the textbook
in multiple choice, true/false, matching, and Diversified Health
short answer format. Occupations, Seventh Edition,
♦ PowerPoint Presentation with over 900 slides
supporting the text for use in classroom lec-
Online Companion
tures. An online companion is available to accompany
the text that includes valuable information for
♦ Electronic Instructor’s Manual in PDF format both the student and instructor.
providing electronic access to the printed
For the student:
Diversified Health Occupations Instructor’s
Manual. ♦ PowerPoint presentation of important con-
♦ Image Library providing a searchable data- cepts
base of electronic versions of the Transpar- ♦ StudyWARETM software that is designed to
ency Masters found in the Diversified Health offer additional review of concepts
Occupations Teacher’s Resource Kit.
♦ Evaluation Checklists from the Student Work-
♦ Multimedia animations narrating difficult to book
visualize anatomical and physical processes,
including The Anatomy of a Cell, The Process ♦ Link to Audio Podcasts of medical termi-
of Hearing, Blood Flow through the Heart, and nology
much more. ♦ Fourteen Animations that make anatomy and
♦ Links to the Online Companion and more. physiology concepts come alive
Preface xv
The Online Companion tools for the instruc- Health Occupations in the State of Ohio and the
tor are on a password-protected site. Tools Diversified Health Occupations Instructor of the
include: Year Award for the State of Ohio. Mrs. Simmers
is retired and lives with her husband in Venice,
♦ Online Instructor’s Manual with answers to
Florida. The author is pleased to announce that
the Student Workbook
her twin daughters will now be assisting with the
♦ PowerPoint Presentation to help you manage revisions of this textbook.
your classroom presentation Karen Simmers-Nartker graduated from Kent
♦ Computerized Test Bank with more than 1,800 State University, Ohio, with a Bachelor of Science
questions. degree in Nursing. She has been employed as a
♦ Evaluation Checklist from the Student Work- telemetry step-down, medical intensive care,
book surgical intensive care, and neurological inten-
sive care nurse. She is currently employed as a
♦ Conversion Grids to help you move from the shift coordinator in an open-heart intensive care
6th edition to the 7th edition of Diversified unit. She has obtained certification from the
Health Occupations Emergency Nurses Association for the Trauma
♦ Fourteen Animations that make anatomy and Nursing Core Course (TNCC) and from the Amer-
physiology concepts come alive ican Heart Association for Advanced Cardiac Life
Support (ACLS). In her current position as charge
To access the companion, go to
nurse in her ICU, she coordinates patient care
http://www.delmarlearning/companions.com.
and staff assignments; manages interpersonal
conflicts among staff and/or patients and family
About the Authors members; is responsible for ensuring quality care
Louise Simmers received a Bachelor of Science to meet the diverse needs of patients and/or fam-
degree in nursing from the University of Maryland ily; actively participates in inservices to evaluate
and an MEd from Kent State University. She has new equipment, medications, hospital services
worked as a public health nurse, medical-surgical and supplies; and teaches and mentors newly
nurse, charge nurse in a coronary-intensive care employed nurses.
unit, instructor of practical nursing, and health Sharon Simmers-Kobelak graduated from
occupations teacher and school-to-work coordi- Miami University, Ohio, with a Bachelor of Busi-
nator at the Madison Comprehensive High School ness Administration degree. She works in the
in Mansfield, Ohio. She is a member of the Univer- educational publishing industry. She has experi-
sity of Maryland Nursing Alumni Association, ence assisting instructors at private career schools
Sigma Theta Tau, Phi Kappa Phi, National Educa- in finding appropriate materials for classroom
tion Association, and Association for Career and instruction. Sharon also provides inservice train-
Technical Education (ACTE), and is a volunteer ing for instructors on how to utilize the instructor
worker for the Red Cross. Mrs. Simmers received and student resources in the most productive
the Vocational Educator of the Year Award for manner.
HOW TO USE
Objectives CHAPTER 16 First Aid
Review these goals before you begin reading a

chapter to help you focus your study. Then, when
you have completed the chapter, go back and Chapter Objectives
review these goals to see if you have grasped the After completing this chapter,
you should be able to:
Observe Standard
key points of the chapter. Precautions

◆ Demonstrate cardiopulmonary resuscitation
for one-person rescue, two-person rescue,
infants, children, and obstructed-airway
Icons
Instructor’s Check—Call victims
Instructor at This Point
◆ Describe first aid for
—bleeding and wounds
Safety—Proceed with —shock
Caution —poisoning
—burns
—heat exposure
Icons are used throughout the text to highlight OBRA Requirement—Based
on Federal Law —cold exposure
—bone and joint injuries, including fractures
specific pieces of information. This icon key is Math Skill

—specific injuries to the eyes, head, nose, ears,
chest, abdomen, and genital organs
—sudden illness including heart attack, stroke,
presented to reinforce the meaning of the icons. Legal Responsibility

fainting, convulsions, and diabetic reactions
◆ Apply dressings and bandages, observing all
safety precautions and using the circular,
Science Skill spiral, figure-eight, and recurrent, or finger
wrap
Career Information ◆ Define, pronounce, and spell all key terms
Technology
30216_16_Ch16_448-527.indd 448 1/11/08 1:21:54 PM
KEY TERMS
Key Terms
acquired immune deficiency contaminated pathogens (path"-oh-jenz!)
syndrome (AIDS) disinfection personal protective
Key Terms highlight the critical vocabu-
aerobic droplet precautions equipment (PPE) lary words you will need to learn.
airborne precautions endogenous portal of entry
anaerobic epidemic portal of exit Pronunciations are also included for the
antisepsis (ant!-ih-sep"-sis) exogenous protective (reverse) isolation harder-to-pronounce words. These
asepsis (a-sep"-sis) fomites protozoa (pro-toe-zo"-ah)
autoclave fungi (fun"-guy) reservoir terms are highlighted within the text
bacteria helminths rickettsiae (rik-et"-z-ah) where they are defined. You will also
bioterrorism hepatitis B standard precautions
causative agent hepatitis C sterile find most of these terms listed in the
cavitation microorganism (my-crow- sterile field glossary section. Use this listing as part
(kav!-ih-tay"-shun) or"-gan-izm) sterilization
chain of infection mode of transmission susceptible host of your study and review of critical
chemical disinfection nonpathogens transmission-based terms.
clean nosocomial isolation precautions
communicable disease opportunistic ultrasonic
contact precautions pandemic viruses
xviii HOW TO USE
TODAY’S RESEARCH: TOMORROW’S HEALTH CARE

Today’s Research:
A bravery gene?
Anxiety and fear have been felt by every human being. However, some individuals are so
anxious or fearful they are not able to function within society. For example, individuals with
agoraphobia have an abnormal fear of being helpless in a situation from which they cannot
Tomorrow’s
escape, so they stay in an environment in which they feel secure. Many agoraphobic people
never leave their homes; they avoid all public or open places. Scientists are not really certain
how fear works in the brain, so conditions such as these are difficult to treat.
Health Care
Recently, scientists working with mice found that by removing a single gene, they could
turn normally cautious animals into brave animals that were more willing to explore an Today’s Research: Tomorrow’s Health Care
unknown territory and were less intimidated by dangers. By analyzing brain tissue, scien-
tists located a gene in a tiny prune-shaped region of the brain called the amygdala, an area
boxes are located in each chapter. These
of the brain that is extremely active when animals or humans are afraid or anxious. This commentaries help you learn about the
gene produces a protein called stathmin, which is highly concentrated in the amygdala but
very hard to detect in other areas of the brain. Scientists removed this stathmin gene and many different types of research occurring
bred a line of mice that were all missing this gene. Tests showed that this breed of mice was
twice as willing to explore unknown territories as unaltered mice. In addition, if the mice
today. If the research is successful, it may
were trained to expect a small electrical shock after being presented with a stimulus such as lead to possible cures and or better meth-
a sound or sight, this group of mice did not seem as fearful when the sound or sight was
given. Researchers are theorizing that stathmin helps form fearful memories in the amyg- ods of treatment in the future for a wide
dala of the brain, the area where unconscious fears seemed to be stored. If the production of
stathmin could be halted or inhibited by medication, it is possible that fears would not be range of diseases and disorders. These
stored as unconscious memories. This would greatly decrease an individual’s anxieties
because unconscious fears are a major cause of anxiety. Think of all of the people whose
boxes of information also highlight the fact
lives are affected by anxiety and fear. If their anxieties and fears could be decreased or elim- that health care changes constantly
inated, they could lead normal healthy lives.
because of new ideas and technology.
Career CAREER HIGHLIGHTS
Highlights Physical therapist assistants provide treatment to improve mobility and prevent or limit
permanent disability of patients with disabling injuries or disease. They are important mem-
bers of the health care team. They work under the supervision of a physical therapist who
has a master’s degree from an accredited program and is licensed (required in all states).
Career Highlights appear in Special Most physical therapist assistants have an associate’s degree from an accredited program
and an internship. Licensure is required in most states.
Health Care Skills chapters. By reading The duties of physical therapist assistants vary but usually include performing exercises;
and understanding the material pre- providing ultrasound or electrical stimulation treatments; administering heat, cold, or moist
applications; ambulating patients with assistive devices; and informing the physical therapist
sented in these boxes, you will learn the of patient’s response and progress. In addition to the knowledge and skills presented in this
chapter, physical therapist assistants must also learn and master skills such as:
educational requirements of each
◆ Presenting a professional ◆ Comprehending anatomy, ◆ Promoting good nutrition
profession, potential places of employ- appearance and attitude physiology, and and a healthy lifestyle to
ment, and additional tasks you may ◆ Obtaining knowledge
pathophysiology with an maintain health
emphasis on the skeletal,
have to perform that are not specifically regarding health care
delivery systems, muscular, nervous, and
◆ Utilizing computer skills
circulatory systems ◆ Cleaning and maintaining
discussed within the chapter. organizational structure, equipment
and teamwork ◆ Observing all safety
precautions ◆ Ordering and maintaining
◆ Meeting all legal
supplies and materials
30216_17_Ch17_528-549.indd 548 responsibilities ◆ Practicing all principles of
1/11/08 1:23:31 PM
infection control ◆ Performing administrative
◆ Communicating
duties such as answering
effectively ◆ Administering first aid
the telephone, scheduling
◆ Being sensitive to and
and cardiopulmonary appointments,
respecting cultural resuscitation completing insurance
diversity forms, and maintaining
◆ Learning medical
patient records
terminology
RELATED HEALTH CAREERS

30216_22_Ch22_930-968.indd 931
Related Health 1/11/08 1:24:32 PM
NOTE: A basic knowledge of human anatomy and physiology is essential for almost every
health care provider. However, some health careers are related to specific body systems. As
each body system is discussed, examples of related health careers are listed. The following
Careers
health career categories require knowledge of the structure and function of the entire human
body and will not be listed in specific body system units. Related Health Careers appear in
Chapter 7, Anatomy and Physiology. By
◆ Athletic Trainer ◆ Medical Assistant ◆ Physician Assistant
◆ Emergency Medical ◆ Medical Illustrator ◆ Physician
reviewing the information presented in
Careers ◆ Nursing Careers ◆ Surgical Technologist these boxes, you will relate specific
◆ Medical Laboratory
Careers
◆ Pharmacy Careers health careers to specific body systems.
30216_07_Ch07_140-234.indd 141 Copyright 2009 Cengage Learning, Inc. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part.
1/11/08 1:46:19 PM
How to Use xix
Information 13:1 INFORMATION

Using Body Mechanics
Sections To prevent injury to yourself and others while

working in the health field, it is important that
you observe good body mechanics.
Body mechanics refers to the way in which
Information sections explain the basic the body moves and maintains balance while
facts of the topic, why you would need making the most efficient use of all its parts. Basic
rules for body mechanics are provided as guide-
this information, and how the informa- lines to prevent strain and help maintain muscle
strength.
tion is applied to various health care There are four main reasons for using good
fields. body mechanics:
♦ Muscles work best when used correctly.
♦ Correct use of muscles makes lifting, pulling,
and pushing easier.
♦ Correct application of body mechanics pre-
vents unnecessary fatigue and strain, and
saves energy.
♦ Correct application of body mechanics pre-
vents injury to self and others.
Eight basic rules of good body mechanics FIGURE 13-1 Maintain a broad base of support
include: by keeping the feet 8–10 inches apart.
♦ Maintain a broad base of support by keep-
ing the feet 8–10 inches apart, placing one foot
slightly forward, balancing weight on both ♦ Use the weight of your body to help push or
feet, and pointing the toes in the direction of pull an object. Whenever possible, push, slide,
movement (figure 13-1). or pull rather than lift.
♦ Bend from the hips and knees to get close to ♦ Carry heavy objects close to the body. Also,
an object, and keep your back straight (figure stand close to any object or person being
13-2). Do not bend at the waist. moved.
♦ Use the strongest muscles to do the job. The ♦ Avoid twisting your body as you work. Turn
larger and stronger muscles are located in the with your feet and entire body when you
shoulders, upper arms, hips, and thighs. Back change direction of movement.
muscles are weak. ♦ Avoid bending for long periods.
30216_13_Ch13_333-349.indd 334 1/11/08 1:25:44 PM
PROCEDURE 15:2B
Procedures
Measuring and mouth. Wait at least 15 minutes if the
Recording Oral
Temperature 5.
patient says “yes” to your question.
Remove the clean thermometer by the
upper end. Use a clean tissue or dry cot-
Sections
ton ball to wipe the thermometer from Procedures sections provide step-by-
Equipment and Supplies stem to bulb.
step instructions on how to perform
Oral thermometer, plastic sheath (if used), NOTE: If the thermometer was soaking
holder with disinfectant solution, tissues or in a disinfectant, rinse first in cool the procedure outlined in the Informa-
water.
dry cotton balls, container for used tissues,
watch with second hand, soapy cotton balls,
tion section. Practice these procedures
CAUTION: Hold the thermometer se-
disposable gloves, notepaper, pencil/pen curely to avoid breaking. until you perform them correctly and
Procedure 6. Read the thermometer to be sure it reads proficiently.
96°F (35.6°C) or lower. Check carefully
for chips or breaks.
1. Assemble equipment.
CAUTION: Never use a cracked ther-
2. Wash hands and put on gloves.
mometer because it may injure the
CAUTION: Follow standard precautions patient.
for contact with saliva or the mucous
7. If a plastic sheath is used, place it on the
membrane of the mouth.
thermometer.
3. Introduce yourself. Identify the patient.
8. Insert the bulb under the patient’s
Explain the procedure.
tongue, toward the side of the mouth
4. Position the patient comfortably. Ask (figure 15-12). Ask the patient to hold it
the patient if he/she has eaten, has had in place with the lips, and caution
hot or cold fluids, or has smoked in the against biting it.
past 15 minutes.
NOTE: Check to be sure patient’s mouth
NOTE: Eating, drinking liquids, or smok- is closed.
ing can affect the temperature in the
30216_15_Ch15_412-447.indd 421 1/11/08 1:26:29 PM
xx HOW TO USE
Full-Color Photos and Illustrations

Illustrations are presented in full color that demonstrate important health care concepts, including the
inner workings of the body. Use these illustrations for review while studying.
Full-color photos are used throughout the text to illustrate important techniques you will be required to
know and demonstrate when working within a health care field.
Sweat pore
Hair shaft
Dermal papilla
Sensory nerve
Stratum ending for touch
corneum
Stratum Epidermis
lucidum
Stratum
Stratum spinosum Dermis
germinativum Stratum
basale
Arrector pili muscle
Sebaceous (oil) gland
Subcutaneous
Hair follicle fatty tissue
(hypodermis)
Papilla of hair
FIGURE 14-20A To remove the first glove,
use a gloved hand to grasp the outside of the
Nerve fiber Vein
glove on the opposite hand. Pull the glove down
Artery and turn it inside out while removing it.
Nerve
Sweat gland
Pacinian corpuscle
FIGURE 7-9 Cross-section of skin.
Internet INTERNET SEARCHES

30216_14_Ch14_350-411.indd
Use the suggested search engines in Chapter 12:4

369 REVIEW QUESTIONS
Searches
1. List the classifications of bacteria by shape and
of this textbook to search the Internet for addi- give two (2) examples of diseases caused by
tional information on the following topics: each class.
1. Organizations regulating infection control: find 2. Draw the chain of infection and identify three
Internet Searches can enhance your the organization sites for the Occupational
Safety and Health Administration (OSHA),
(3) ways to break each section of the chain.
comprehension of the chapter informa- Centers for Disease Control and Prevention 3. Differentiate between antisepsis, disinfection,
(CDC), National Center for Infectious Diseases and sterilization.
tion by offering you the chance to read (NCID), and the Hospital Infection Control 4. Develop a plan showing at least five (5) ways
information on the chapter topics. Practices Advisory Committee (HICPAC) to
obtain information on regulations governing
you can protect yourself and your family from
a bioterrorism attack.
Review
infection control
5. List eight (8) times the hands must be washed.
2. Microbiology: search for specific information
on bacteria (can also search for specific types 6. Name the different types of personal protective
equipment (PPE) and state when each type
Questions
such as Escherichia coli), protozoa, fungi,
rickettsiae, and viruses must be worn to meet the requirements of
standard precautions.
3. Diseases: obtain information on the method of
transmission, signs and symptoms, treatment, 7. What level of infection control is achieved by
Review Questions enhance your com- and complications for diseases such as hepati- an ultrasonic cleaner? chemicals? an auto-
tis B, hepatitis C, acquired immune deficiency clave?
prehension of chapter content. After syndrome, and specific diseases listed by the 8. Name three (3) methods that can be used to
you have completed the chapter discussion on microorganisms in this unit place sterile items on a sterile field. Identify the
4. Infections: research endogenous infections, types of items that can be transferred by each
reading, try to answer the review exogenous infections, nosocomial infections, method.
questions at the end of the chapter. If and opportunistic infections
you find yourself unable to answer the

questions, go back and review the
chapter again.
30216_07_Ch07_140-234.indd 152 1/11/08 1:44:38 PM
HOW TO USE
DIVERSIFIED HEALTH
OCCUPATIONS,
SEVENTH EDITION,
STUDYWARE™
MINIMUM SYSTEM
REQUIREMENTS
♦ Operating systems: Microsoft Windows 2000, Windows XP, Win-
dows Vista
♦ Processor: Minimum required by operating system
♦ Memory: Minimum required by operating system
♦ Screen resolution: 800 # 600 pixels
♦ Color depth: 16-bit color (thousands of colors)
♦ Macromedia Flash Player 9. The Macromedia Flash Player is free,
and can be downloaded from http://www.adobe.com/products/
flashplayer/
INSTALLATION
INSTRUCTIONS
1. Insert disc into CD-ROM player. Diversified Health Occupations,
Seventh Edition, StudyWARETM installation program should start
up automatically. If it does not, go to step 2.
2. From My Computer, double-click on the icon for the CD drive.
3. Double-click on the setup.exe file to start the program.
TECHNICAL SUPPORT
Telephone: 1-800-648-7450; 8:30 A.M.–5:30 P.M. Eastern Time
Fax: 1-518-881-1247
E-mail: delmar.help@cengage.com
StudyWARE™ is a trademark used herein under license.
Microsoft® and Windows® are registered trademarks of the Microsoft
Corporation.
Pentium® is a registered trademark of the Intel Corporation.
xxii HOW TO USE
GETTING STARTED
The StudyWARETM software is designed to enhance your learning. As
you study each chapter in the text, be sure to explore the activities in
the corresponding chapter in the software. Use StudyWARETM as
your own private tutor to help you learn the material in the text.
Getting started is easy. Install the software by inserting the CD and
following the on-screen instructions. Enter your first and last name so
that the software can store you quiz results. Then choose a chapter
from the menu and take a quiz or explore one of the activities.
Menus
You can access any of the menus from wherever
you are within the program. The menus include
Quizzes, Scores, Activities, and Animations.
How to Use xxiii
Quizzes
Quizzes include multiple choice and fill-in questions. You
can take the quizzes in both Practice Mode and Quiz Mode.
Use Practice Mode to improve your mastery of the material.
You have multiple tries to get the answers correct. Instant
feedback tells you whether you are right or wrong—and
helps you learn quickly by explaining why an answer was
correct or incorrect. Use Quiz Mode when you are ready to
test yourself and keep a record of your scores. In Quiz Mode,
you have one try to get the answers right, but you can take
each Quiz as many times as you want.
Scores
You can view your last scores for each quiz
and print out your results to hand in to your
instructor.
xxiv HOW TO USE
Activities
Activities include Flashcards, Crossword, Hang-
man, Ordering and Sorting, and a Jeopardy!-style
Championship Game. Have fun while increasing
your knowledge.
Animations
Animations help you visualize concepts related to
pathological conditions and anatomy.
ACKNOWLEDGMENTS
This seventh edition of Diversified Health Occupations is dedicated

to my grandchildren, Hayden Michael Kobelak, Kaleigh Ann Nartker,
Kyla Ann Kobelak, Jesse Louise Nartker, and Brady Wayne Nartker!
Our grandchildren help keep us young and bring so much joy and
pleasure into our lives.
The author would like to thank everyone who participated in the
development of this text, including
Nancy L. Raynor, former Chief Consultant, Head Occupations
Education, State of North Carolina, who served as a consultant
and major mentor in the initial development of this textbook
Dr. Charles Nichols. Department Head, and Ray Jacobs, Teacher
Educator, Kent State University
Nancy Webber, RN, Diversified Health Occupations Instructor
Each person who consented to be a subject in the photographs
Administrative staff at Madison Comprehensive High School
Carolynn Townsend, Lisa Shearer Cooper, Donna Story, and
Dorothy Fishman, who contributed chapter information
Kathryn G. Cutlip, Health and Safety Services Director at Rich-
land County Red Cross, who reviewed and contributed informa-
tion for the First Aid Chapter
Sharon Logan, a true friend and health care professional, who
never hesitates to review new material, research information,
critique the manuscript, and offer encouragement
The author and Delmar would like to thank those individuals
who reviewed the manuscript and offered suggestions, feedback,
and assistance. The text has been improved as a result of the review-
ers’ helpful, insightful, and creative suggestions. Their work is greatly
appreciated.
Becky Carter
Health Science Instructor
Charlotte, North Carolina
xxvi ACKNOWLEDGMENTS
Eleanore Cross Linda Stanhope

Health Science Instructor Texas State Curriculum Writer
Scotland High School Health Science Instructor
Laurinburg, North Carolina Amarillo, Texas
Beverly Fenley Kathy Turner
Health Science Technology Instructor Health Occupations Consultant
Academy of Irving North Carolina Department of Public
Irving, Texas Instruction
Cary, North Carolina
Christine Glass
ROP Instructor at Weber Institute Debra Ziegler, RN, BS
Stockton Unified School District Health Sciences Instructor
Lodi, California Ralston High School
Ralston, Nebraska
Natalie Kelly
Health Science Instructor The author also wishes to thank the following
Hardaway High School companies, associations, and individuals for
Columbus, Georgia information and/or illustrations.
Julee T. Kristeller, RN A-dec, Inc.
Health Occupations Instructor
Gray’s Creek High School American Cancer Society
Hope Mills, North Carolina American Optometric Association
Diane Sharp Becton Dickinson
Kentucky Department of Education
Career and Technical Education Timothy Berger, MD
Frankfort, Kentucky Bruce Black, MD
Lara Skaggs Boehringer Mannheim
State Program Manager
Health Careers Education Brevis Corporation
Oklahoma Department of CareerTech
Briggs Corporation
Education
Stillwater, Oklahoma Marcia Butterfield
Acknowledgments xxvii
Carson’s Scholar Fund Omron Healthcare

Centers for Disease Control and Prevention Pfizer
CIBA Pharmaceutical Company Philips Electronic Instruments
Sandy Clark Phoenix Society of Burn Survivors, Inc
The Clorox Company Photodisc
Control-o-fax Office Systems Poly-Medco
Exergen Corporation Professional Innovations
Food and Drug Administration (FDA) Patrick Reineck, DDS
Deborah Funk, MD Sage Products, Inc.
G.E. Medical Systems Salk Institute
Health Occupations Students of America Robert A. Silverman
HemoCue® SkillsUSA
Hill-Rom Smead Manufacturing
Hollister Incorporated Spacelabs Medical, Inc.
Hu-Friedy Manufacturing Company Ron Stram, MD
J.T. Posey Company Sunrise Medical
Kardex Systems 3M Company
Kerr Corporation U.S. Army
Medline Industries U.S. Department of Agriculture
Michigan Pharmacist Association U.S. Postal Systems
Miltex Instrument Company W.A. Foote Memorial Hospital
National Eye Institute
National Hospice and Palliative Care
Organization
PART 1 Basic Health Care
Concepts & Skills
Welcome to the world of health science technology educa-

tion. You have chosen a career in a field that offers endless
opportunities. If you learn and master the knowledge and
skills required, you can find employment in any number of
rewarding occupations.
There will always be a need for workers in health care
careers because such workers provide services that cannot
be performed by automation or a machine. Thus, although
the future will bring changes, you will always be an impor-
tant part of providing needed care or services.
The material that follows will provide you with a good
start toward your career goal. As you learn to use the infor-
mation presented in the pages that follow, I encourage you to
always continue to learn and to grow. All material is pre-
sented in a manner to make learning as easy as possible.
However, you must still make the effort to achieve the stan-
dards set and to perform to the best of your ability.
I expect that you will find this book different from previ-
ous books that you have used. If you read the pages that
begin each part, you will understand how to use this book. I
think you will enjoy working with it, because it will allow you
to constantly see how much progress you are making. In
addition, it is probably the only book you will have used that
allows you to practice tests or evaluations before you actually
take them.
One final word. You are entering a field that provides one
of the greatest rewards: that of working to assist others.
Although the work is hard at times, you will always have the
satisfaction of knowing that you are helping other people. So,
be proud of yourself. When you learn the concepts and skills
well, you will provide services that are appreciated by all.
Introduction
This part is divided into 17 chapters, each covering several
topics designed to provide you with the basic knowledge and
skills required for many different health careers. Before start-
ing a chapter, read the objectives so you will know exactly what is expected of you. The objectives
identify the competencies you should have mastered upon completing the chapter.
Diversified Health Occupations, 7th edition, has a textbook and a workbook. Each chapter in
the textbook is subdivided into Information sections. At the end of most of these sections is a
statement telling you to go to the workbook to complete an assignment sheet on the information
covered. Some chapters also include Procedure sections, each of which refers you to an evalua-
tion sheet in the workbook. Following are brief explanations of these main components.
1. Information Sections (Textbook): The Information sections provide the basic knowledge you
must acquire. These sections explain why the knowledge is important, the basic facts regard-
ing the particular topic, and how this information is applied in various health careers. Most
Information sections refer you to specific assignment sheets in the workbook. Some Informa-
tion sections provide the basic knowledge you need to perform a given procedure. These
sections explain why things are done, give necessary facts, stress key points that should be
observed, and, again, refer you to specific assignment sheets in the workbook.
2. Assignment Sheets (Workbook): The assignment sheets provide review of the main facts and
information presented in the textbook. After you have read an Information section in the
text, try to answer the questions on the assignment sheet. Refer back to the Information sec-
tion to see if your answers are correct. Let your instructor grade your completed assignment
sheets. Note any changes or corrections. Be sure you understand the information before
moving to another Information section or performing the corresponding procedure.
3. Procedure Sections (Textbook): The Procedure sections provide step-by-step instructions on
how to perform the procedures. Follow the steps while you practice the procedures. Each
procedure begins with a list of the necessary equipment and supplies. On occasion, you will
see any or all of three words within the procedure sections: Note, Caution, and Check-
point. Note means to carefully read the comments following, which usually stress points of
knowledge or explain why certain techniques are used. Caution means that a safety factor is
involved and that you should proceed carefully while doing the step in order to avoid injuring
yourself or the patient. Checkpoint means to ask your instructor to check you at that point
in the procedure. Checkpoints are usually located at critical points in the procedures. Each
procedure section refers you to a specific evaluation sheet in the workbook.
4. Evaluation Sheets (Workbook): Each evaluation sheet contains a list of criteria on which you
will be tested when you have mastered a particular procedure. Make sure that your perfor-
mance meets the standards set. When you feel you have mastered a particular procedure,
sign the evaluation sheet and give it to your instructor. Your instructor will grade you by using
the listed criteria and checking each step against your performance.
In addition to these components, you will also find a list of References at the end of the text-
book. For additional information about the topics discussed, refer to these references.
Finally, you will notice various icons throughout the textbook. Their purpose is to accentuate
particular factors or denote specific types of knowledge. The icons and their meanings are as
follows:
Observe Standard Precautions Math Skill Career Information
Instructor’s Check—Call
Legal Responsibility Communications Skill
Safety—Proceed with Caution Science Skill Technology
OBRA Requirement—Based on
Federal Law
CHAPTER 1 History and Trends
of Health Care
Chapter Objectives
After completing this chapter,
Observe Standard
Precautions
◆ Differentiate between early beliefs about the
cause of disease and treatment and current
beliefs about disease and treatment
◆ Identify at least 10 major events in the history
of health care
◆ Name at least six historical individuals and
Safety—Proceed with
Caution
explain how each one has helped to improve
health care today
◆ Create a time line showing what you believe
OBRA Requirement—Based
on Federal Law
are the 20 most important discoveries in health
care and explain why you believe they are
important
Math Skill
◆ Identify at least five current trends or changes
in health care
Legal Responsibility
◆ Define, pronounce, and spell all key terms
Science Skill
Career Information
Technology
History and Trends of Health Care 3
KEY TERMS
alternative therapies geriatric care outpatient services
complementary therapies holistic health care pandemic
cost containment home health care telemedicine
diagnostic related groups integrative health care wellness
(DRGs) Omnibus Budget
energy conservation Reconciliation Act (OBRA)
NOTE: To further emphasize the Key Terms, they appear in color in the chapter copy. You will notice beginning
in Chapter 3 on page 39 that pronunciations have been provided for the more difficult key terms. The single
accent mark, _!_, shows where the main stress is placed when saying the word. The double accent, _"_, shows
secondary stress (if present in the word).
ing the structure of the human body was limited

1:1 INFORMATION because most religions did not allow dissection,
History of Health Care or cutting apart of the body. For this reason, ani-
mals were frequently dissected to learn about dif-
Why is it important to understand the history of ferent body parts.
health care? Would you believe that some of the The ancient Egyptians were the first people to
treatment methods in use today were also used in record health records. It is important to remem-
ancient times? In the days before drug stores, ber that many people could not read; therefore,
people used many herbs and plants as both food knowledge was limited to an educated few. Most
and medicine. Many of these herbs remain in use of the records were recorded on stone and were
today. A common example is a medication called created by priests, who also acted as physicians.
morphine. Morphine is made from a poppy plant The ancient Chinese had a strong belief in the
and is used to manage pain. As you review each need to cure the spirit and nourish the entire
period of history, think about how the discoveries body. This form of treatment remains important
have helped to improve the health care you today, when holistic health methods stress treat-
receive today. ing the entire patient—mind, body, and soul.
Hippocrates (ca 460–377 BC), called the
“Father of Medicine,” was one of the most impor-
ANCIENT TIMES tant physicians in ancient Greece (figure 1-1).
The records that he and other physicians created
Table 1-1 lists many of the historical events of helped establish that disease is caused by natural
health care in ancient times. In primitive times, causes, not by supernatural spirits and demons.
the common belief was that disease and illness The ancient Greeks were also among the first to
were caused by evil spirits and demons. Treat- stress that a good diet and cleanliness would help
ment was directed toward eliminating the evil to prevent disease.
spirits. As civilizations developed, changes With knowledge obtained from the Greeks,
occurred as people began to study the human the Romans realized that some diseases were
body and make observations about how it func- connected to filth, contaminated water, and poor
tions. sanitation. They began the development of sani-
Religion played an important role in health tary systems by building sewers to carry away
care. A common belief was that illness and dis- waste and aqueducts (waterways) to deliver clean
ease were punishments from the gods. Religious water. They drained swamps and marshes to
rites and ceremonies were frequently used to reduce the incidence of malaria. They created
eliminate evil spirits and restore health. Explor- laws to keep streets clean and eliminate garbage.
4 CHAPTER 1
TABLE 1-1 History of Health Care in Ancient Times

HISTORICAL EVENTS OF HEALTH CARE IN ANCIENT TIMES
4000 BC–3000 BC Believed that illness and disease were caused by supernatural spirits and demons
Primitive Times Tribal witch doctors treated illness with ceremonies to drive out evil spirits
Herbs and plants used as medicines and some, such as morphine for pain and digitalis for the
heart, are still used today
Trepanation or trephining (boring a hole in the skull) was used to treat insanity, epilepsy, and
headache
Average life span was 20 years
3000 BC–300 BC Earliest people known to maintain accurate health records
Ancient Egyptians Called upon the gods to heal them when disease occurred
Physicians were priests who studied medicine and surgery in temple medical schools
Imhotep (2635–2595? BC) may have been the first physician
Believed the body was a system of channels for air, tears, blood, urine, sperm, and feces
If channels became “clogged,” bloodletting or leeches were used to “open” them
Used magic and medicinal plants to treat disease
Average life span was 20 to 30 years
1700 BC–220 AD Religious prohibitions against dissection resulted in inadequate knowledge of body structure
Ancient Chinese Carefully monitored the pulse to determine the condition of the body
Believed in the need to treat the whole body by curing the spirit and nourishing the body
Recorded a pharmacopoeia of medications based mainly on the use of herbs
Used acupuncture, or puncture of the skin by needles, to relieve pain and congestion
Also used moxibustion (a powdered substance was placed on the skin and then burned to cause
a blister) to treat disease
Began the search for medical reasons for illness
1200 BC–200 BC Began modern medical science by observing the human body and effects of disease
Ancient Greeks Biochemist Alcmaeon in 6th century BC identified the brain as the physiological site of the senses
Hippocrates (460–377 BC) called the Father of Medicine:
• Developed an organized method to observe the human body
• Recorded signs and symptoms of many diseases
• Created a high standard of ethics, the Oath of Hippocrates, used by physicians today
Aristotle (384–322 BC) dissected animals and is called the founder of comparative anatomy
Believed illness is a result of natural causes
Used therapies such as massage, art therapy, and herbal treatment that are still used today
Stressed diet and cleanliness as ways to prevent disease
753 BC–410 AD First to organize medical care by providing care for injured soldiers
Ancient Romans Early hospitals developed when physicians cared for ill people in rooms in their homes
Later hospitals were religious and charitable institutions housed in monasteries and convents
Began public health and sanitation systems:
• Created aqueducts to carry clean water to the cities
• Built sewers to carry waste materials away from the cities
• Used filtering systems in public baths to prevent disease
• Drained marshes to reduce the incidence of malaria
Claudius Galen (129–199? AD), a physician, established many medical beliefs:
• Body regulated by four fluids or humors: blood, phlegm, black bile, and yellow bile
• An imbalance in the humors resulted in illness
• Described symptoms of inflammation and studied infectious diseases
• Dissected animals and determined function of muscles, kidney, and bladder
Diet, exercise, and medications were used to treat disease
THE DARK AGES AND

MIDDLE AGES
Table 1-2 lists many of the historical events of the
Dark Ages and the Middle Ages. During the Dark
Ages, after the fall of the Roman empire, the study
of medicine stopped. Individuals again lived in
unsanitary conditions with little or no personal
hygiene. Epidemics of smallpox, dysentery, typhus,
and the plague were rampant. Monks and priests
stressed prayer to treat illness and disease.
The Middle Ages brought a renewed interest
in the medical practices of the Romans and
Image not available due to copyright restrictions Greeks. Monks obtained and translated the writ-
ings of the Greek and Roman physicians, and
recorded the knowledge in handwritten books.
Medical universities were created in the 9th cen-
tury to train physicians how to use this knowl-
edge to treat illness. Later, Arabs began requiring
that physicians pass examinations and obtain
licenses.
In the 1300s, a major epidemic of bubonic
plague killed almost 75 percent of the popula-
tion of Europe and Asia. Other diseases such as
smallpox, diphtheria, tuberculosis, typhoid, and
malaria killed many others. The average life span
of 20 to 35 years was often reduced even more
by the presence of these diseases. Many infants
died shortly after birth. Many children did not
live into adulthood. Today, most of these diseases
are almost nonexistent. They are prevented by
vaccines or treated by medications.
THE RENAISSANCE
Table 1-3 lists many of the historical events that
occurred between 1350 and 1650 AD, a period
The first hospitals were also established in ancient known as the Renaissance. This period often
Rome when physicians began caring for injured refers to the “rebirth of science of medicine.” The
soldiers or ill people in their homes. major source of new information about the
Although many changes occurred in health human body was a result of accepting and allow-
care during ancient times, treatment was still lim- ing human dissection. Doctors could now view
ited. The average person had poor personal body organs and see the connection between
hygiene, drank contaminated water, and had different systems in the body. Artists, such as
unsanitary living conditions. Diseases such as Michelangelo and Leonardo da Vinci, were able
typhoid, cholera, malaria, dysentery, leprosy, and to draw the body accurately. In addition, the
smallpox infected many individuals. Because the development of the printing press resulted in
causes of these diseases had not been discovered, the publication of medical books that were
the diseases were usually fatal. The average life used by students at medical universities. Knowl-
span was 20 to 35 years. Today, individuals who edge spread more rapidly. Physicians were more
die at this age are considered to be young people. educated.
6 CHAPTER 1
TABLE 1-2 History of Health Care in the Dark Ages and the Middle Ages
HISTORICAL EVENTS OF HEALTH CARE IN THE DARK AGES AND THE MIDDLE AGES
400–800 AD Emphasis was placed on saving the soul and the study of medicine was prohibited
Dark Ages Prayer and divine intervention were used to treat illness and disease
Monks and priests provided custodial care for sick people
Medications were mainly herbal mixtures
800–1400 AD Renewed interest in the medical practice of Greeks and Romans
Middle Ages Physicians began to obtain knowledge at medical universities in the 9th century
A pandemic (worldwide epidemic) of the bubonic plague (black death) killed three quarters of the
population of Europe and Asia
Major diseases were smallpox, diphtheria, tuberculosis, typhoid, the plague, and malaria
Arab physicians used their knowledge of chemistry to advance pharmacology
Rhazes (al-Razi), an Arab physician, became known as the Arab Hippocrates:
• Based diagnoses on observations of the signs and symptoms of disease
• Developed criteria for distinguishing between smallpox and measles in 910 AD
• Suggested blood was the cause of many infectious diseases
• Began the use of animal gut for suture material
Arabs began requiring that physicians pass examinations and obtain licenses
Avenzoar, a physician, described the parasite causing scabies in the 12th century
TABLE 1-3 History of Health Care in the Renaissance

HISTORICAL EVENTS OF HEALTH CARE IN THE RENAISSANCE
1350–1650 AD Rebirth of science of medicine

Renaissance Dissection of the body began to allow a better understanding of anatomy and physiology
Artists Michelangelo (1475–1564) and Leonardo da Vinci (1452–1519) used dissection to draw the
human body more realistically
First chairs (positions of authority) of medicine created at Oxford and Cambridge in England in 1440
Development of the printing press allowed knowledge to be spread to others
First anatomy book was published by Andreas Vesalius (1514–1564)
First book on dietetics written by Isaac Judaeus
Michael Servetus (1511–1553):
• Described the circulatory system in the lungs
• Explained how digestion is a source of heat for the body
Roger Bacon (1214?–1294):
• Promoted chemical remedies to treat disease
• Researched optics and refraction (bending of light rays)
TABLE 1-4 History of Health Care in the 16th, 17th, and 18th Centuries
HISTORICAL EVENTS OF HEALTH CARE IN THE 16TH, 17TH, AND 18TH CENTURIES
16th and 17th Causes of disease were still not known and many people died from infections and puerperal (child-
Centuries birth) fever
Ambroise Paré (1510–1590), a French Surgeon, known as the Father of Modern Surgery:
• Established use of ligatures to bind arteries and stop bleeding
• Eliminated use of boiling oil to cauterize wounds
• Improved treatment of fractures and promoted use of artificial limbs
Gabriel Fallopius (1523–1562):
• Identified the fallopian tubes in the female
• Described the tympanic membrane in the ear
William Harvey (1578–1657) described the circulation of blood to and from the heart in 1628
Anton van Leeuwenhoek (1632–1723) invented the microscope in 1666
First successful blood transfusion on animals performed in England in 1667
Bartolomeo Eustachio identified the eustachian tube leading from the ear to the throat
Scientific societies, such as the Royal Society of London, were established
Apothecaries (early pharmacists) made, prescribed, and sold medications
18th Century Gabriel Fahrenheit (1686–1736) created the first mercury thermometer in 1714
Joseph Priestley (1733–1804) discovered the element oxygen in 1774
John Hunter (1728–1793), an English surgeon:
• Established scientific surgical procedures
• Introduced tube feeding in 1778
Benjamin Franklin (1706–1790) invented bifocals for glasses
Dr. Jessee Bennet performed the first successful Cesarean section operation to deliver an infant in
1794
James Lind prescribed lime juice containing vitamin C to prevent scurvy in 1795
Edward Jenner (1749–1823) developed a vaccination for smallpox in 1796
The life span increased to an average age of A major development was the invention of
30 to 40 years during the Renaissance, but com- the microscope by Anton van Leeuwenhoek (fig-
mon infections still claimed many lives. At this ure 1-2). This allowed physicians to see organ-
point in time, the actual causes of disease were isms that are too small to be seen by the human
still a mystery. eye. Even though they were not aware of it at the
time, physicians were looking at many of the
pathogenic organisms (germs) that cause dis-
THE 16TH, 17TH, AND ease. The microscope continues to be a major
18TH CENTURIES diagnostic tool.
This period also saw the start of drug stores, or
Table 1-4 lists many of the historical events that pharmacies. Apothecaries (early pharmacists)
occurred during the 16th, 17th, and 18th centu- made, prescribed, and sold medications. Many of
ries. During this period, physicians gained an the medications were made from plants and herbs
increased knowledge of the human body. William similar to those used in ancient times. At the end
Harvey described the circulation of blood. Gabriel of the 18th century, Edward Jenner developed a
Fallopius described the tympanic membrane in vaccine to prevent smallpox, a deadly disease.
the ear and the fallopian tubes of a female. Bar- During this time, the average life span
tolomeo Eustachio identified the tube between increased to 40 to 50 years. However, the causes
the ear and throat. These discoveries allowed of many diseases were still unknown, and medi-
other physicians to see how the body functioned. cal care remained limited.
8 CHAPTER 1
Anton van Leeuwenhoek (1632–1723) is one of sev- René-Théophile-Hyacinthe Laënnec (1781–1826) was
eral individuals who are called the “Father of Microbiol- a French physician who is frequently called the “Father
ogy” because of his discovery of bacteria and other of Pulmonary Diseases.” In 1816, he invented the
microscopic organisms. He was born in Delft, Holland, stethoscope, which began as a piece of rolled paper
and worked as a tradesman and apprentice to a textile and evolved into a wooden tube that physicians
merchant. van Leeuwenhoek learned to grind lenses inserted into their ears.
and make simple microscopes to use while examining Laënnec used his stethoscope to listen to the various
the thread densities of materials. sounds made by the heart and lungs. For years he stud-
In 1668, he visited London and saw a copy of Robert ied chest sounds and correlated them with diseases
Hookes’s Micrographia, a book depicting Hookes’s own found on autopsy. In 1819, he published a book on his
observations with the microscope. This stimulated van findings, De l’auscultation mediate, also known as On
Leeuwenhoek’s interest and he began to build micro- Mediate Auscultation. Laënnec’s use of auscultation (lis-
scopes that magnified more than 200 times, with clearer tening to internal body sounds) and percussion (tapping
and brighter images than were available at the time. body parts to listen to sounds) formed the basis of the
Using the improved microscope, van Leeuwenhoek diagnostic techniques used in medicine today.
began to observe bees, bugs, water, and other similar Laënnec studied and diagnosed many medical con-
substances. He noticed tiny single-celled organisms that ditions such as bronchiectasis, melanoma, cirrhosis,
he called animalcules, now known as microorganisms. and tuberculosis. Cirrhosis of the liver is still called
When van Leeuwenhoek reported his observations to Laënnec’s cirrhosis because Laënnec was the first phy-
the Royal Society of London, he was met with skepti- sician to recognize this condition as a disease entity.
cism. However, other scientists researched his findings, Laënnec also conducted extensive studies on tubercu-
and eventually his ideas were proved and accepted. losis, but unfortunately he was not aware of the conta-
van Leeuwenhoek was the first individual to record giousness of the disease and contracted tuberculosis
microscopic observations on muscle fibers, blood ves- himself. He died at the age of 45 of tuberculosis, leaving
sels, and spermatozoa. He laid the foundations of plant a legacy of knowledge that is still used by physicians
anatomy and animal reproduction. He developed a today.
method for grinding powerful lenses and made more
than 400 different types of microscopes. Anton van FIGURE 1-3 René Laënnec (Courtesy of Parke-
Leeuwenhoek’s discoveries are the basis for microbiol- Davis and Company, copyright 1957)
ogy today.
FIGURE 1-2 Anton van Leeuwenhoek

allowed physicians to listen to internal body
sounds, which increased their knowledge of the
THE 19TH CENTURY human body. The original stethoscope, a rolled
piece of paper, quickly evolved into a wooden
Table 1-5 lists many of the historical events that tube that was inserted into the physician’s ear.
occurred during the 19th century, a period also Formal training for nurses began during this
known as the Industrial Revolution. Major progress century. After training at a program in Germany,
in medical science occurred because of the devel- Florence Nightingale established sanitary nurs-
opment of machines and ready access to books. ing care units for injured soldiers during the
Early in the century, René Laënnec invented Crimean War. She is known as the founder of
the stethoscope (figure 1-3). This invention modern nursing (figure 1-4).
TABLE 1-5 History of Health Care in the 19th Century

HISTORICAL EVENTS OF HEALTH CARE IN THE 19TH CENTURY
19th Century Royal College of Surgeons (medical school) founded in London in 1800
French barbers acted as surgeons by extracting teeth, using leeches for treatment, and giving enemas
First federal vaccination legislation enacted in 1813
First successful blood transfusion was performed on humans in 1818 by James Blundell
René Laënnec (1781–1826) invented the stethoscope in 1816
Dr. Philippe Pinel (1755–1826) began humane treatment for mental illness
Pandemic of cholera in 1832
Theodor Fliedner started one of the first training programs for nurses in Germany in 1836, which
provided Florence Nightingale with her formal training
In the 1840s, Ignaz Semmelweis (1818–1865) encouraged physicians to wash their hands with lime
after performing autopsies and before delivering babies to prevent puerperal (childbirth) fever, but the
idea was resisted by hospital and medical personnel
Dr. William Morton (1819–1868), an American dentist, began using ether as an anesthetic in 1846
Dr. James Simpson (1811–1870) began using chloroform as an anesthetic in 1847
American Medical Association was formed in Philadelphia in 1847
Elizabeth Blackwell (1821–1910) became the first female physician in the United States in 1849;
started the first Women’s Medical College in New York in 1868
American Pharmaceutical Association held its first convention in 1853
Florence Nightingale (1820–1910) was the founder of modern nursing:
• Established efficient and sanitary nursing units during Crimean War in 1854
• Opened Nightingale School and Home for Nurses at St. Thomas’ Hospital in London in 1860
• Began the professional education of nurses
Dorothea Dix (1802–1887) appointed Superintendent of Female Nurses of the Army in 1861
International Red Cross was founded in 1863
Joseph Lister (1827–1912) started using disinfectants and antiseptics during surgery to prevent infec-
tion in 1865
Elizabeth Garrett Anderson (1836–1917) became the first female physician in Britain in 1870 and the
first woman member of the British Medical Association in 1873
Paul Ehrlich (1854–1915), a German bacteriologist, developed methods of detecting and differentiating
between various diseases, developed the foundation for modern theories of immunity, and used
chemicals to eliminate microorganisms
Francis Clarke and M. G. Foster patented the first electrical hearing aid in 1880
Clara Barton (1821–1912) founded the American Red Cross in 1881
Robert Koch (1843–1910), another individual who is also called the “Father of Microbiology,” devel-
oped the culture plate method to identify pathogens and in 1882 isolated the bacteria that causes
tuberculosis
Louis Pasteur (1822–1895) contributed many discoveries to the practice of medicine including:
• Proving that microorganisms cause disease
• Pasteurizing milk to kill bacteria
• Creating a vaccine for rabies in 1885
Gregory Mendel (1822–1884) established principles of heredity and dominant/recessive patterns
Dimitri Ivanofski discovered viruses in 1892
Lillian Wald (1867–1940) established the Henry Street Settlement in New York City in 1893 (the start
of public health nursing)
Dr. Emile Roux of Paris developed a vaccine for diphtheria in 1894
Wilhelm Roentgen (1845–1923) discovered roentgenograms (X-rays) in 1895
Almroth Wright developed a vaccine for typhoid fever in 1897
Bayer introduced aspirin in powdered form in 1899
Bacteria causing gonorrhea and leprosy were discovered and identified
10 CHAPTER 1
Florence Nightingale (1820–1910) is known as the Louis Pasteur (1822–1895) was a French chemist and
founder of modern nursing. In 1854, Nightingale led 38 biologist. He is also called the “Father of Microbiological
nurses to serve in the Crimean War. During the war, Sciences and Immunology” because of his work with
the medical services of the British army were horrifying the microorganisms that cause disease. Pasteur devel-
and inadequate. Hundreds of soldiers died because of oped the germ theory and discovered the processes of
poor hygiene and unsanitary conditions. Nightingale pasteurization, vaccination, and fermentation. His germ
fought for the reform of the military hospitals and for theory proved that microorganisms cause most infec-
improved medical care. tious diseases. He proved that heat can be used to
Nightingale encouraged efficiency and cleanliness destroy harmful germs in perishable food, a process
in the hospitals. Her efforts decreased the death rate of now known as “pasteurization.” Pasteur also discovered
patients by two thirds. She used statistics to prove that that weaker microorganisms could be used to immunize
the number of deaths decreased with improved sani- against more poisonous forms of a microorganism. He
tary conditions. Because of her statistics, sanitation developed vaccines against anthrax, chicken cholera,
reforms occurred and medical practice improved. rabies, and swine erysipelas. Through his studies of fer-
One of Nightingale’s greatest accomplishments was mentation, he proved that each disease is caused by a
starting the Nightingale Training School for nurses at specific microscopic organism.
St. Thomas’ Hospital in London. Nurses attending her Pasteur’s principles for sanitation helped control the
school received a year’s training, which included lec- spread of disease and provided ideas on how to pre-
tures and practical ward work. Trained nurses were vent disease. These discoveries reformed surgery and
then sent to work in British hospitals and abroad. These obstetrics. Pasteur is responsible for saving the lives of
trained nurses also established other nursing schools millions of people through vaccination and pasteuriza-
by using Nightingale’s model. Nightingale published tion. His accomplishments are the foundation of bacte-
more than 200 books, pamphlets, and reports. Her riology, immunology, microbiology, molecular biology,
writings on hospital organization had a lasting effect in and virology in today’s health care.
England and throughout the world. Many of her princi- FIGURE 1-5 Louis Pasteur (Courtesy of Parke-
ples are still used in health care today.
Davis and Company, copyright 1957)
FIGURE 1-4 Florence Nightingale (Courtesy of
Parke-Davis, a division of Warner-Cambert the army. Clara Barton founded the American
Company) Red Cross (figure 1-6).
The average life span during this period
Infection control was another major develop- increased to 40 to 65 years. Treatment for disease
ment. Physicians began to associate the tiny was more specific after the causes for diseases
microorganisms seen in the microscope with dis- were identified. Many vaccines and medications
eases. Methods to stop the spread of these organ- were developed.
isms were developed by Theodor Fliedner, Joseph
Lister, and Louis Pasteur (figure 1-5).
Women became active participants in medi-
cal care. Elizabeth Blackwell was the first female
THE 20TH CENTURY
physician in the United States. Dorothea Dix was Table 1-6 lists many of the historical events that
appointed superintendent of female nurses in occurred during the 20th century. This period
Francis Crick and James Watson shared the Nobel

Clara Barton (1821–1912) is known as the founder of Prize in 1962 with Maurice Wilkins for discovering the
the American Red Cross. During the American Civil structure of deoxyribonucleic acid (DNA). Crick is a
War, she served as a volunteer to provide aid to biophysicist and chemist. Watson studied zoology.
wounded soldiers. She appealed to the public to pro- They met at the University of Cambridge and shared a
vide supplies and, after collecting the supplies, person- desire to solve the mystery of the structure of DNA.
ally delivered them to soldiers of both the North and Crick and Watson built a three-dimensional model
the South. of the molecules of DNA to assist them in discovering
In 1869, Barton went to Geneva, Switzerland, to the structure. In 1953, they discovered that the struc-
rest and improve her health. During her visit she ture of DNA is a double helix, similar to a gently twisted
learned about the Treaty of Geneva, which provided ladder. It consists of pairs of bases, including adenine
relief for sick and wounded soldiers. A dozen nations and thymine, and guanine and cytosine. The order in
had signed the treaty, but the United States had which these bases appear on the double helix deter-
refused. She also learned about the International Red mines the identity of a living organism. That is, DNA
Cross, which provided disaster relief during peacetime carries life’s hereditary information.
and war. Crick and Watson’s model of the DNA double helix
When Barton returned to the United States, she provided motivation for research in molecular genetics
campaigned for the Treaty of Geneva until it was rati- and biochemistry. Their work showed that understand-
fied. In 1881, the American Red Cross was formed. ing how a structure is arranged is critical to under-
Barton served as its first president. She represented standing how it functions. Crick and Watson’s discovery
the American Red Cross by traveling all over the United is the foundation for most of the genetic research that
States and the world to assist victims of natural disas- is being conducted today.
ters and war.
FIGURE 1-7A Francis Crick and James Watson
FIGURE 1-6 Clara Barton (Courtesy of the (Courtesy of the Salk Institute)
National Archives, photo no. 111-B-4 246, Brady
Collection)
(figures 1-7A and B). Their studies began the
showed the most rapid growth in health care. search for gene therapy to cure inherited dis-
Physicians were able to use new machines such eases. This research continues today.
as X-rays to view the body. Medicines, including Health care plans to help pay the costs of care
insulin for diabetes, antibiotics to fight infec- also started in the 20th century. At the same time,
tions, and vaccines to prevent diseases, were standards were created to make sure that every
developed. The causes for many diseases were individual had access to quality health care. This
identified. Physicians were now able to treat the remains a major concern of health care in the
cause of a disease to cure the patient. United States today.
A major development to understanding the The first open-heart surgery in the 1950s has
human body occurred in the 1950s when Francis progressed to the heart transplants that occur
Crick and James Watson described the structure today. Surgical techniques have provided cures
of DNA and how it carries genetic information for what were once fatal conditions. Infection
12 CHAPTER 1
Nucleus (1)
Cell membrane
Basic
cell DNA
molecule (3)
Gene (4)
Cytoplasm
Chromosomes (2)
FIGURE 1-7B The discovery of the structure of DNA and how it carries genetic (inherited) information was
the beginning of research on how to cure inherited diseases by gene therapy.
TABLE 1-6 History of Health Care in the 20th Century

20th Century Walter Reed demonstrated that mosquitoes carry yellow fever in 1900
Carl Landsteiner classified the ABO blood groups in 1901
Female Army Nurse Corps established as a permanent organization in 1901
Miller Reese of New York patented the battery-driven hearing aid in 1901
Dr. Harry Plotz developed a vaccine against typhoid in 1903
Dr. Elie Metchnikoff (1845–1916) identified how white blood cells protect against disease
Marie Curie (1867–1934) isolated radium in 1910
Sigmund Freud’s (1856–1939) studies formed the basis for psychology and psychiatry
Influenza (flu) pandemic killed more than 21 million people in 1918
Frederick Banting and Charles Best discovered and used insulin to treat diabetes in 1922
Health insurance plans and social reforms were developed in the 1920s
Mary Breckinridge (1881–1965) founded Frontier Nursing Service in 1925 to deliver health care to
rural Kentuckians
John Enders and Frederick Robbins developed methods to grow viruses in cultures in the 1930s
Sir Alexander Fleming (1881–1955) discovered penicillin in 1928
Buddy, a German shepherd, became the first guide dog for the blind in 1928
Dr. Robert Smith (Dr. Bob) and William Wilson founded Alcoholics Anonymous in 1935
President Franklin Roosevelt established the March of Dimes to fight poliomyelitis in 1937
Gerhard Domagk (1895–1964) developed sulfa drugs to fight infections
Dr. George Papanicolaou developed the Pap test to detect cervical cancer in females in 1941
The first kidney dialysis machine was developed in 1944
Jonas Salk (1914–1995) developed the polio vaccine using dead polio virus in 1952
Francis Crick and James Watson described the structure of DNA and how it carries genetic information
in 1953
(continues)
TABLE 1-6 History of Health Care in the 20th Century (Continued)

The first heart–lung machine was used for open-heart surgery in 1953
Conjoined (Siamese) twins were separated successfully for the first time in 1953
The first successful kidney transplant in humans was performed by Joseph Murray in 1954
Albert Sabin (1906–1993) developed an oral live-virus polio vaccine in the mid-1950s
Birth control pills approved by the U.S. Food and Drug Administration (FDA) in 1960
An arm severed at the shoulder was successfully reattached to body in 1962
The first liver transplant was performed by Thomas Starzl in 1963
The first lung transplant was performed by James Hardy in 1964
Medicare and Medicaid 1965 Amendment to Social Security Act marked the entry of the federal gov-
ernment into the health care arena as a major purchaser of health services
The first successful heart transplant was performed by Christian Barnard in 1967
The first hospice was founded in England in 1967
Hargobind Khorana synthesized a gene in 1970
Health Maintenance Organization Act of 1973 established standards for HMOs and provided an alterna-
tive to private health insurance
Physicians used amniocentesis to diagnose inherited diseases before birth in 1975
Computerized axial tomography (CAT) scan was developed in 1975
New Jersey Supreme Court ruled that parents of Karen Ann Quinlan, a comatose woman, had the
power to remove life support systems in 1975
The first “test tube” baby, Louise Brown, was born in England in 1978
Genetic engineering led to development of vaccines against hepatitis, herpes simplex, and chicken pox
in the 1980s
Acquired immune deficiency syndrome (AIDS) was identified as a disease in 1981
Dr. William DeVries implanted the first artificial heart, the Jarvik-7, in 1982
Cyclosporine, a drug to suppress the immune system after organ transplants, approved in 1983
The Human immunodeficiency virus (HIV) causing AIDS was identified in 1984
The Omnibus Budget Reconciliation Act (OBRA) of 1987 established regulations for the education and
certification of nursing assistants
The Omnibus Budget Reconciliation Act of 1989 created an agency for health care policy and research
to develop outcome measures of health care quality
The first gene therapy to treat disease occurred in 1990
President George H. Bush signed the Americans with Disabilities Act in 1990
The National Center for Complementary and Alternative Medicine (NCCAM) was established by the
National Institutes of Health (NIH) to research and establish standards of quality care in 1992
A vaccine for chicken pox was approved in 1995
The British government admitted that an outbreak of “mad cow” disease was linked to Creutzfeldt–
Jacob disease in humans in 1996
President Clinton signed the Health Insurance Portability and Accountability Act (HIPAA) of 1996 to
protect patient privacy and to make it easier to obtain and keep health insurance
Identification of genes causing diseases increased rapidly in the 1990s
A sheep was cloned in 1997
The first successful larynx (voice box) transplant was performed in 1998
An international team of scientists sequenced the first human chromosome in 1999
control has helped decrease surgical infections periods combined. Today, computers are used in
that previously killed many patients. every aspect of health care. Their use will increase
The contribution of computer technology to even more in the 21st century.
medical science has helped medicine progress All of these developments have helped
faster in the 20th century than in all previous increase the average life span to 60 to 80 years. In
14 CHAPTER 1
age system. After the operation, both boys were able to

survive independently. This result was the first surgery to
separate occipital craniopagus twins, meaning they were
joined at the head near the occipital bone. In 1997, Dr. Car-
son was the lead surgeon in South Africa in another suc-
cessful operation to separate 11-month-old boys who were
vertical craniopagus twins, meaning they were joined at
the top of the head looking in opposite directions.
Dr. Carson continues to perform landmark surgeries
and conduct research for new techniques and procedures.
He has refined hemispherectomy, a revolutionary surgical
procedure performed on the brain to stop seizures that
are difficult to treat or cure. He works with craniofacial
(head or facial disfigurement) reconstructive surgery. Dr.
Carson has developed an important craniofacial program
that combines neurosurgery and plastic surgery for chil-
dren with congenital (at birth) deformities. He is also
known for his work in pediatric neurooncology (brain
tumors).
Dr. Carson is the author of three best-selling books:
Benjamin Carson, MD, has become famous for his land- Gifted Hands, the story of his life; Think Big, a story inspir-
mark surgeries to separate conjoined twins. Dr. Carson is ing others to use their intelligence; and The Big Picture, a
one of the most skilled and accomplished neurosurgeons close-up look at the life of a professional surgeon. Dr. Car-
today. son is also cofounder and president of the Carson Schol-
In 1987, he was the primary surgeon of a 70- ar’s Fund. This fund was established to recognize young
member surgical team that separated Siamese twins from people for superior academic performance and humani-
West Germany. The 7-month-old boys were joined at the tarian achievement.
back of the head, sharing the major cerebral blood drain-
FIGURE 1-8 Benjamin Carson, MD (Courtesy of Carson Scholar’s Fund)

fact, it is not unusual to see people live to be 100. At the same time, however, scientists now
With current pioneers such as Ben Carson (figure have computers and rapid methods of communi-
1-8), as well as many other medical scientists and cation to share new knowledge. Organizations
physicians, there is no limit to what future health such as the World Health Organization (WHO), an
care will bring. international agency sponsored by the United
Nations, are constantly monitoring health prob-
lems throughout the world and taking steps to
THE 21ST CENTURY prevent pandemics. Health care has become a
global concern and countries are working together
The potential for major advances in health care to promote good health in all individuals.
in the 21st century is unlimited. Early in the cen- Table 1-7 lists some of the events that have
tury, the completion of the Human Genome Proj- occurred so far in the 21st century and some pos-
ect by the U.S. Department of Energy and the sible advances that might occur soon. The poten-
National Institutes of Health (NIH) provided the tial for the future of health care has unlimited
basis for much of the current research on genet- possibilities.
ics. Research with embryonic stem cells and
development of cloned cells could lead to treat-
ments that will cure many diseases.
Some major threats to health care exist in this
century. Bioterrorism, the use of microorganisms 1:2 INFORMATION
or biologic agents as weapons to infect humans,
is a real and present threat. New viruses, such as
Trends in Health Care
the bird flu virus, could mutate and cause disease Health care has seen many changes during the
in humans. Pandemics, or worldwide epidemics, past several decades, and many additional
could occur quickly in our global society because changes will occur in the years to come. An aware-
people can travel easily from one country to ness of such changes and trends is important for
another. any health care worker.
TABLE 1-7 History of Health Care in the 21st Century

HISTORICAL EVENTS OF HEALTH CARE IN THE 21ST CENTURY
21st Century Adult stem cells were used in the treatment of disease early in the 2000s
The U.S. Food and Drug Administration (FDA) approved the use of the abortion pill RU-486 in 2000
President George W. Bush approved federal funding for research using only existing lines of em-
bryonic stem cells in 2001
Advanced Cell Technology announced it cloned a human embryo in 2001 but the embryo did not
survive
The first totally implantable artificial heart was placed in a patient in Louisville, Kentucky, in 2001
Smallpox vaccinations were given to military personnel and first responders to limit the effects of a
potential bioterrorist attack in 2002
The Netherlands became the first country in the world to legalize euthanasia in 2002
The Human Genome Project to identify all of the approximately 20,000 to 25,000 genes in human
DNA was completed in 2003
The Standards for Privacy of Individually Identifiable Health Information, required under the Health
Insurance Portability and Accountability Act (HIPAA) of 1996, went into effect in 2003
The Medicare Prescription Drug Improvement and Modernization Act was passed in 2003
The virus that causes severe acute respiratory syndrome (SARS) was identified in 2003 as a new
coronavirus, never seen in humans previously
National Institutes of Health (NIH) researchers discover that primary teeth can be a source of stem
cells in 2003
First face transplant was performed in France in 2005 on a woman whose lower face was destroyed
by a dog attack
Stem cell researchers at the University of Minnesota coaxed embryonic stem cells to produce
cancer-killing cells in 2005
The National Cancer Institute (NCI) and the National Human Genome Research Institute started a
project to map genes associated with cancer so mutations that occur with specific cancers can be
identified in 2006
The FDA approved the use of the AbioCor totally implantable artificial heart in 2006
The first inhalable insulin product, Exubera, was approved by the FDA in 2006
Researchers propose a new method to generate embryonic stem cells from a blastocyst without
destroying embryos in 2006
Gardasil, a vaccine to prevent cervical cancer, was approved by the FDA in 2006
Zostavax, a vaccine to prevent herpes zoster (shingles), was approved by the FDA in 2006
Potential for the Cures for AIDS, cancer, and heart disease are found
21st Century Genetic manipulation to prevent inherited diseases is a common practice
Development of methods to slow the aging process or stop aging are created
Nerves in the brain and spinal cord are regenerated to eliminate paralysis
Transplants of every organ in the body, including the brain, are possible
Antibiotics are developed that do not allow pathogens to develop resistance
Average life span is increased to 90 to 100 years and beyond
COST CONTAINMENT ♦ Technological advances: highly technical pro-

cedures such as heart, lung, liver, or kidney
Cost containment, a term heard frequently in transplants can cost hundreds of thousands of
health care circles, means trying to control the dollars. Even so, many of these procedures are
rising cost of health care and achieving the maxi- performed daily throughout the United States.
mum benefit for every dollar spent. Some reasons Artificial hearts are another new technology
for high health care costs include: being used. Computers that can be used to
16 CHAPTER 1
examine internal body parts are valuable diag- example, a large medical laboratory with
nostic tools, but these devices can cost mil- expensive computerized equipment perform-
lions of dollars. Advanced technology does ing thousands of tests per day can provide
allow people to survive illnesses that used to quality service at a much lower price than
be fatal, but these individuals may require smaller laboratories with less expensive equip-
expensive and lifelong care. ment capable of performing only a limited
♦ The aging population: older individuals use numbers of tests per day.
more pharmaceutical products (medications), ♦ Outpatient services: patients receive care
have more chronic diseases, and often need without being admitted to hospitals or other
frequent health care services. care facilities. Hospital care is expensive.
♦ Health-related lawsuits: lawsuits force health Reducing the length of hospital stays or
care providers to obtain expensive malprac- decreasing the need for hospital admissions
tice insurance, order diagnostic tests even lowers the cost of health care. For example,
though they might not be necessary, and make patients who had open-heart surgery used to
every effort to avoid lawsuits by practicing spend several weeks in a hospital. Today, the
defensive health care. average length of stay is 5 to 7 days. Less
expensive home care or transfer to a skilled-
Because these expenses must be paid, a major
care facility can be used for individuals who
concern is that health care costs could rise to lev-
require additional assistance. Surgery, radio-
els that could prohibit providing services to all
graphs, diagnostic tests, and many other pro-
individuals. However, everyone should have
cedures that once required admission to a
equal access to care regardless of their ability to
hospital are now done on an outpatient basis.
pay. Because of this, all aspects of health care are
directed toward cost containment. Although ♦ Mass or bulk purchasing: buying equipment
there is no firm answer to controlling health costs, and supplies in larger quantities at reduced
most agencies that deliver health care are trying prices. This can be done by combining the
to provide quality care at the lowest possible purchases of different departments in a single
price. Some methods of cost containment that agency, or by combining the purchases of sev-
are used include: eral different agencies. A major health care
system purchasing medical supplies for hun-
♦ Diagnostic related groups (DRGs): one dreds or thousands of health care agencies
way Congress is trying to control costs for gov- can obtain much lower prices than an indi-
ernment insurance plans such as Medicare and vidual agency. Computerized inventory can
Medicaid. Under this plan, patients with cer- be used to determine when supplies are
tain diagnoses who are admitted to hospitals needed and to prevent overstocks and waste.
are classified in one payment group. A limit is
placed on the cost of care, and the agency pro- ♦ Early intervention and preventive services: pro-
viding care receives this set amount. This viding care before acute or chronic disease
encourages the agency to make every effort to occurs. Preventing illness is always more cost-
provide care within the expense limit allowed. effective than treating illness. Methods used
If the cost of care is less than the amount paid, to prevent illness include patient education,
the agency keeps the extra money. If the cost of immunizations, regular physical examina-
care is more than the amount paid, the agency tions to detect problems early, incentives for
must accept the loss. individuals to participate in preventive activi-
ties, and easy access for all individuals to pre-
♦ Combination of services: done to eliminate
ventive health care services. Studies have
duplication of services. Clinics, laboratories
shown that individuals with limited access to
shared by different agencies, health mainte-
health services and restricted finances use
nance organizations (HMOs), preferred pro-
expensive emergency rooms and acute care
vider organizations (PPOs), and other similar
facilities much more frequently. Providing
agencies all represent attempts to control the
early intervention and care to these individu-
rising cost of health care. When health care
als is much more cost-efficient.
agencies join together or share specific ser-
vices, care can be provided to a larger number ♦ Energy conservation: monitoring the use of
of people at a decreased cost per person. For energy to control costs and conserve resources.
Major expenses for every health care industry/ respiratory therapy, social services, nutritional
agency are electricity, water, and/or gas. Most and food services, and other types of care can be
large health care facilities perform energy provided in the home environment.
audits to determine how resources are being
used and to calculate ways to conserve energy.
Methods that can be used for energy conserva- GERIATRIC CARE
tion include designing and building new
energy-efficient facilities; constantly monitor- Geriatric care, or care for the elderly, is
ing and maintaining heating/cooling systems; another field that will continue to experience
using insulation and thermopane windows to rapid growth in the future (figure 1-9). This is
prevent hot/cool air loss; repairing plumbing caused in part by the large number of individuals
fixtures immediately to stop water loss; replac- who are experiencing longer life spans because of
ing energy-consuming lightbulbs with fluores- advances in health care. Many people now enjoy
cent or energy-efficient bulbs; installing life spans of 80 years or more. Years ago, very few
infrared sensors to turn water faucets on and people lived to be 100 years old. This is becoming
off; and using alternative forms of energy such more and more common. Also, the “baby boom”
as solar power. Recycling is also a form of generation—the large number of people born
energy conservation, and most health care after World War II—is now reaching the geriatric
facilities recycle many different materials. age classification. Projections from the U.S. Cen-
sus Bureau indicate that the rate of population
The preceding are just a few examples of cost growth during the next 50 years will be slower for
containment. Many other methods will undoubt- all age groups, but the number of people in older
edly be applied in the years ahead. It is important age groups will continue to grow more than twice
to note that the quality of health care should not as rapidly as the total population. Many different
be lowered simply to control costs. To prevent this facilities will be involved in providing care and
from happening, the Agency for Health Care Pol- resources for this age group. Adult day care cen-
icy and Research (AHCPR) researches the quality ters, retirement communities, assisted/indepen-
of health care delivery and identifies the standards dent living facilities, long-term care facilities, and
of treatment that should be provided. In addition, other organizations will all see increased demand
every health care worker must make every effort for the services they provide.
to provide quality care while doing everything
possible to avoid waste and keep expenditures
down. Health care consumers must assume more
responsibility for their own care, become better
informed of all options for health care services,
and follow preventive measures to avoid or limit
illness and disease. Everyone working together
can help control the rising cost of health care.
HOME HEALTH CARE

Home health care is a rapidly growing
field. Diagnostic related groups and shorter
hospital stays have created a need for providing
care in the home. Years ago, home care was the
usual method of treatment. Doctors made house
calls, private duty nurses cared for patients in the
patients’ homes, babies were delivered at home,
and patients died at home. Current trends show a
return to some of these practices. Home care is
also another form of cost containment because it
is usually less expensive to provide this type of
care. All aspects of health care can be involved. FIGURE 1-9 Geriatric care is a field that will
Nursing care, physical and occupational therapy, continue to experience rapid growth.
18 CHAPTER 1
OBRA the Omnibus Budget Reconcilia- As consumers become computer literate,

tion Act (OBRA) of 1987 has led to the more health care services will be provided elec-
development of many regulations regarding long- tronically. Telemedicine machines, operating over
term care and home health care. This act requires telephone lines, are “user-friendly,” compact, and
states to establish training and competency eval- less expensive than when they were developed.
uation programs for nursing and geriatric assis- They are already allowing individuals with chronic
tants. Each assistant working in a long-term care illnesses or disabilities to receive care in the com-
facility or home health care is now required under fort of their homes. This decreases the need for
federal law to complete a mandatory, state- trips to medical care facilities. Patients can test
approved training program and pass a written blood sugar levels, oxygen levels, blood pressure
and/or competency examination to obtain certi- measurements, and other vital signs, and send
fication or registration. OBRA also requires con- the results to a physician/nurse; monitor pace-
tinuing education, periodic evaluation of makers; use online courses to learn how to man-
performance, and retraining and/or testing if a age their condition; schedule an “appointment”
nursing assistant does not work in a health care to talk with a health care provider “face to face”
facility for more than 2 years. Each state then through video monitors; receive electronic
maintains a registry of qualified individuals. reminders to take medications or perform diag-
The minimum skills required are specified in nostic tests; and receive answers to specific health
the Nurse Aide Competency Evaluation Program questions. In rural areas, where specialty care is
(NACEP) developed by the National Council of State often limited, telemedicine can provide a patient
Boards of Nursing. Programs that prepare nursing with access to specialists thousands of miles away.
and geriatric assistants use NACEP as a guideline to Telemedicine will become an important way of
ensure that the minimum requirements of OBRA delivering health care in future years.
are met. Many programs expand these require-
ments. OBRA also requires compliance with
patients’/residents’ rights, and forces states to
establish guidelines to ensure that such rights are
WELLNESS
observed and enforced. These regulations serve to Wellness, or the state of being in optimum
ensure certain standards of care. As the need for health with a balanced relationship between
geriatric care increases, additional regulations may physical, mental, and social health, is another
be created. It is important that every health care major trend in health care. People are more aware
worker be informed about all OBRA regulations to of the need to maintain health and prevent disease
comply with these regulations. because disease prevention improves the quality
of life and saves costs. More individuals are recog-
nizing the importance of exercise, good nutrition,
TELEMEDICINE weight control, and healthy living habits (figure
1-10). This has led to the establishment of well-
Telemedicine involves the use of video, audio, ness centers, weight-control facilities, health food
and computer systems to provide medical and/ stores, nutrition services, stress reduction coun-
or health care services. New technology now seling, and habit cessation management.
allows interactive services between health care Wellness is determined by the lifestyle choices
providers even though they are in different loca- made by an individual and involves many factors.
tions. For example, emergency medical techni- Some of the factors and ways to promote well-
cians (EMTs), at the scene of an accident or ness include:
illness, can use technology to transmit medical
data such as an electrocardiogram to an emer- ♦ Physical wellness: promoted by a well-bal-
gency department physician. The physician can anced diet; regular exercise; routine physical
then monitor the data and direct the care of the examinations and immunizations; regular
patient. Surgeons using a computer can guide a dental and vision examinations; and avoid-
remote-controlled arm (robotic) to perform sur- ance of alcohol, tobacco, caffeine, drugs, envi-
gery on a patient many miles away. In other ronmental contaminants, and risky sexual
instances, a surgeon can direct the work of behavior
another surgeon by watching the procedure on ♦ Emotional wellness: promoted by understand-
video beamed by a satellite system. ing personal feelings and expressing them
toration. It is based on the body’s natural healing

powers, the various ways different tissues and
systems in the body influence each other, and the
effect of the external environment. It is essential
to remember that the patient is responsible for
choosing his or her own care. Health care workers
must respect the patient’s choices and provide
care that promotes the well-being of the whole
person.
COMPLEMENTARY AND
ALTERNATIVE METHODS
OF HEALTH CARE
The most common health care system in the
United States is the biomedical or “Western” sys-
tem. It is based on evaluating the physical signs
FIGURE 1-10 Individuals are recognizing the and symptoms of a patient, determining the cause
importance of exercise and healthy living habits.
of disease, and treating the cause. A major trend,
(Courtesy of Photodisc)
however, is an increase in the use of complemen-
tary or alternative (CAM) health care therapies.
appropriately, accepting one’s limitations, Complementary therapies are methods of
adjusting to change, coping with stress, enjoy- treatment that are used in conjunction with con-
ing life, and maintaining an optimistic out- ventional medical therapies. Alternative thera-
look pies can be defined as methods of treatment that
♦ Social wellness: promoted by showing con- are used in place of biomedical therapies. Even
cern, fairness, affection, tolerance, and respect though the two terms are different, the term alter-
for others; communicating and interacting native is usually applied whether or not the ther-
well with others; sharing ideas and thoughts; apy is used in place of, or in conjunction with,
and practicing honesty and loyalty conventional medical therapies.
♦ Mental and intellectual wellness: promoted by Many health care facilities now offer inte-
being creative, logical, curious, and open- grative (integrated) health care, which uses
minded; using common sense; obtaining con- both mainstream medical treatments and CAM
tinual learning; questioning and evaluating therapies to treat a patient. For example, chronic
information and situations; learning from life pain is treated with both medications and CAM
experiences; and using flexibility and creativ- therapies that encourage stress reduction and
ity to solve problems relaxation. Integrative health care is based on the
principle that individuals have the ability to bring
♦ Spiritual wellness: promoted by using values, greater wellness and healing into their own lives
ethics, and morals to find meaning, direction, and that the mind affects the healing process. In
and purpose to life; often includes believing in addition, integrative care recognizes that each
a higher authority and observing religious person is unique and may require different medi-
practices cal treatments and a variety of CAM therapies.
The trend toward wellness has led to holistic For this reason, an integrative treatment plan
health care, or care that promotes physical, must be individualized to meet the patient’s own
emotional, social, intellectual, and spiritual well- special needs and circumstances.
being by treating the whole body, mind, and The interest in holistic health care has
spirit. Each patient is recognized as a unique per- increased the use of CAM therapies. Common
son with different needs. Holistic health care uses threads in these therapies are that they consider
many methods of diagnosis and treatment in the whole individual and recognize that the
addition to traditional Western medical practice. health of each part has an effect on the person’s
Treatment is directed toward protection and res- total health status; that each person has a life
20 CHAPTER 1
force or special type of energy that can be used in

the healing process; and that skilled practitio-
ners, rituals, and specialized practices are a part
of the therapy. Many of these therapies are based
on cultural values and beliefs. A few examples of
CAM practitioners include:
♦ Ayurvedic practitioners: use an ancient phi-
losophy, ayurveda, developed in India to
determine a person’s predominant dosha
(body type) and prescribe diet, herbal treat-
ment, exercise, yoga, massage, minerals, and
living practices to restore and maintain har-
mony in the body
♦ Chinese medicine practitioners: use an ancient
holistic-based healing practice based on the
belief that a life energy (Chi) flows through
every living person in an invisible system of
meridians (pathways) to link the organs
together and connect them to the external
environment or universe; use acupuncture
(figure 1-11), acupressure, tai chi, and herbal
remedies to maintain the proper flow of energy
and promote health
FIGURE 1-11 Acupuncture therapists insert very
♦ Chiropractors: believe that the brain sends thin needles into specific points along the meridians
vital energy to all body parts through nerves in (pathways) in the body to stimulate and balance the
the spinal cord; when there is a misalignment flow of energy.
of the vertebrae (bones), pressure is placed on
spinal nerves that results in disease and pain;
use spinal manipulation, massage, and exer-
cise to adjust the position of the vertebrae and expensive than other traditional treatments.
restore the flow of energy Many insurance programs now cover a wide vari-
ety of CAM therapies.
♦ Homeopaths: believe in the ability of the body Because of the increased use of CAM thera-
to heal itself through the actions of the immune pies, the federal government established
system; use minute diluted doses of drugs the National Center for Complementary and
made from plant, animal, and mineral sub- Alternative Medicine (NCCAM) at the National
stances to cause symptoms similar to the dis- Institutes of Health in 1992. Its purpose is to
ease and activate the immune system research the various therapies and determine
♦ Hypnotists: help an individual obtain a trance- standards of quality care. In addition, many states
like state with the belief that the person will be have passed laws to govern the use of various
receptive to verbal suggestions and able to therapies. Some states have established stan-
make a desired behavior change dards for some therapies, forbidden the use of
♦ Naturopaths: use only natural therapies such others, labeled specific therapies experimental,
as fasting, special diets, lifestyle changes, and and require a license or certain educational
supportive approaches to promote healing; requirements before a practitioner can adminis-
avoid the use of surgery or medicinal agents to ter a particular therapy. It is essential for health
treat disease care workers to learn the legal requirements of
their states regarding the different CAM thera-
Many different therapies are used in CAM pies. Health care workers must also remember
medicine. Some of these therapies are discussed that patients have the right to choose their
in Table 1-8. Most of the therapies are noninva- own type of care. A nonjudgmental attitude is
sive and holistic. In many instances, they are less essential.
TABLE 1-8 Complementary and Alternative Therapies

THERAPY BASIC DESCRIPTION
Acupressure Pressure is applied with fingers, palms, thumbs, or elbows to specific pressure points of the
(Shiatsu) body to stimulate and regulate the flow of energy; based on the belief that Chi (life energy)
flows through meridians (pathways) in the body, and illness and pain occur when the flow is
blocked; used to treat muscular–joint pain, depression, digestive problems, and respiratory
disorders; Shiatsu is the Japanese form of acupressure
Acupuncture Ancient Chinese therapy that involves the insertion of very thin needles into specific points
along the meridians (pathways) in the body to stimulate and balance the flow of energy; at
times, heat (moxibustion) or electrical stimulation is applied to the needles; based on the belief
that Chi (life energy) flows through the meridians, and illness and pain occur when the flow is
blocked; used to relieve pain, especially headache and back pain, reduce stress-related
illnesses, and treat drug dependency and obesity
Antioxidants Nutritional therapy that encourages the use of substances called antioxidants to prevent or
(Free Radicals) inhibit oxidation (chemical process in which a substance is joined to oxygen) and neutralize
free radicals (molecules that can damage body cells by altering the genetic code); examples of
antioxidants are vitamins A, C, and E, and selenium; may prevent heart disease, cataracts, and
some types of cancer
Aromatherapy Therapeutic use of selected fragrances (concentrated essences or essential oils that have been
extracted from roots, bark, plants, and/or flowers) to alter mood and restore the body, mind,
and spirit; fragrances may be diluted in oils for massages or placed in warm water or candles
for inhalation; used to relieve tense muscles and tension headaches or backaches, lower blood
pressure, and cause a stimulating, uplifting, relaxing, or soothing effect
Biofeedback Relaxation therapy that uses monitoring devices to provide a patient with information about
his/her reaction to stress by showing the effect of stress on heart rate, respirations, blood
pressure, muscle tension, and skin temperature; patient is then taught relaxation methods to
gain “mind” or voluntary control over the physical responses; used to treat hypertension (high
blood pressure), migraine headaches, and stress-related illnesses, and to enhance relaxation
Healing Touch Ancient Japanese/Tibetan healing art based on the idea that disease causes an imbalance in
(Reiki) the body’s energy field; begins with centering (inward focus of total serenity) before gentle
hand pressure is applied to the body’s chakras (energy centers) to harness and balance the life
energy force, help clear blockages, and stimulate healing; at times, hands are positioned
slightly above the energy centers; used to promote relaxation, reduce pain, and promote
wound healing
Herbal or Botanical Herbal medicine treatments that have been used in almost all cultures since primitive times;
Medicine based on the belief that herbs and plant extracts, from roots, stems, seeds, flowers, and
leaves, contain compounds that alter blood chemistry, remove impurities, strengthen the
immune system, and protect against disease
Homeopathy Treatment based on using very minute, dilute doses of drugs made from natural substances
to produce symptoms of the disease being treated; based on the belief that these substances
stimulate the immune system to remove toxins and heal the body; very controversial form of
treatment
Hydrotherapy Type of treatment that uses water in any form, internally and externally, for healing purposes;
common external examples include water aerobics and exercises, massage in or under water,
soaking in hot springs or tubs, and steam vapors; a common internal example is a diet that
encourages drinking large amounts of water to help cleanse the body and stimulate the
digestive tract
(continues)
22 CHAPTER 1
TABLE 1-8 Complementary and Alternative Therapies (Continued)

Hypnotherapy Technique used to induce a trancelike state so a person is more receptive to suggestion;
(Hypnosis) enhances a person’s ability to form images; used to encourage desired behavior changes such
as helping people lose weight, stop smoking, reduce stress, and/or relieve pain
Imagery Technique of using imagination and as many senses as possible to visualize a pleasant and
soothing image; used to decrease tension, anxiety, and adverse effects of chemotherapy
Ionization Special machines called air ionizers are used to produce negatively charged air particles or
Therapy ions; used to treat common respiratory disorders
Macrobiotic Diet Macrobiotic (meaning “long life”) is a nutrition therapy based on the Taoist concept of the bal-
ance between yin (cold, death, and darkness) and yang (heat, life, and light) and the belief that
different foods represent yin (sweet foods) and yang (meat and eggs); diet encourages
balanced foods such as brown rice, whole grains, nuts, vegetables, fruits, and fish; discour-
ages overindulgence of yin or yang foods; processed and treated foods, red meat, sugar, dairy
products, eggs, and caffeine should be avoided; similar to the American Dietary Association’s
low-fat, low-cholesterol, and high-fiber diet
Meditation Therapy that teaches breathing and muscle relaxation techniques to quiet the mind by focusing
attention on obtaining a sense of oneness within oneself; used to reduce stress and pain, slow
heart rate, lower blood pressure, and stimulate relaxation
Pet Therapy Therapy that uses pets, such as dogs, cats, and birds, to enhance health and stimulate an
interest in life; helps individuals overcome physical limitations, decrease depression, increase
self-esteem, socialize, and lower stress levels and blood pressure
Phytochemicals Nutritional therapy that recommends foods containing phytochemicals (nonnutritive plant
chemicals that store nutrients and provide aroma and color in plants) with the belief that the
chemicals help prevent disease; found mainly in a wide variety of fruits and vegetables, so
these are recommended for daily consumption; used to prevent heart disease, stroke, cancer,
and cataracts
Play Therapy Therapy that uses toys to allow children to learn about situations, share experiences, and express
their emotions; important aspect of psychotherapy for children with limited language ability
Positive Thought Therapy that involves developing self-awareness, self-esteem, and love for oneself to allow the
body to heal itself and eliminate disease; based on the belief that disease is a negative process
that can be reversed by an individual’s mental processes
Reflexology Ancient healing art based on the concept that the body is divided into ten equal zones that run
from the head to the toes; illness or disease of a body part causes deposits of calcium or acids
in the corresponding part of the foot; therapy involves applying pressure on specific points on
the foot so energy movement is directed toward the affected body part; used to promote
healing and relaxation, reduce stress, improve circulation, and treat asthma, sinus infections,
irritable bowel syndrome, kidney stones, and constipation
Spiritual Therapies Therapies based on the belief that a state of wholeness or health depends not only on physical
health, but the spiritual aspects of an individual; uses prayer, meditation, self-evaluation, and
spiritual guidance to allow an individual to use the powers within to increase the sense of well-
being and promote healing
Tai Chi Therapies based on the ancient theory that health is harmony with nature and the universe and a
balanced state of yin (cold) and yang (heat); uses a series of sequential, slow, graceful, and
precise body movements combined with breathing techniques to improve energy flow (Chi)
within the body; improves stamina, balance, and coordination and leads to a sense of well-
being; used to treat digestive disorders, stress, depression, and arthritis
TABLE 1-8 Complementary and Alternative Therapies (Continued)

Therapeutic Treatment that uses kneeling, gliding, friction, tapping, and vibration motions by the hands to
(Swedish) Massage increase circulation of the blood and lymph, relieve musculoskeletal stiffness, pain, and
spasm, increase range-of-motion, and induce relaxation
Therapeutic Touch Therapy based on an ancient healing practice with the belief that illness is an imbalance in an
individual’s energy field; the practitioner assesses alterations or changes in a patient’s energy
fields, places his/her hands on or slightly above the patient’s body, and balances the energy
flow to stimulate self-healing; used to encourage relaxation, stimulate wound healing, increase
the energy level, and decrease anxiety
Yoga Hindu discipline that uses concentration, specific positions, and ancient ritual movements to
maintain the balance and flow of life energy; encourages the use of both the body and mind to
achieve a state of perfect spiritual insight and tranquility; used to increase spiritual enlighten-
ment and well-being, develop an awareness of the body to improve coordination, relieve stress
and anxiety, and increase muscle tone
affects a high proportion of the population. A

NATIONAL HEALTH major concern today is that worldwide pandem-
CARE PLAN ics will become more and more frequent. Because
society is global and individuals can travel readily
The high cost of health care and large number of throughout the world, disease can spread much
uninsured individuals have created a demand for more rapidly from individual to individual.
a national health care plan. Many different types The World Health Organization (WHO) is
of plans have been proposed. One plan involves concerned about influenza pandemics occurring
nationalized medicine, where the federal govern- in the near future. Throughout history, influenza
ment would pay for all health services and levy pandemics have killed large numbers of people.
taxes to pay for those services. Another plan For example, the 1918 Spanish flu pandemic
involves the creation of health care cooperatives, killed approximately 2.6 percent of individuals
which would allow consumers to purchase health who contracted it, or about 40 million people.
care at lower costs. A third plan is based on man- Recently, researchers identified the virus that
aged care and requires employers to provide cov- caused this epidemic as an avian (bird) flu virus
erage and the federal government to subsidize that jumped directly to humans. This caused a
insurance for the poor. Still another plan would major alarm throughout the world because of the
allow each state to establish its own health care avian flu viruses, called H5N1 viruses, which are
plan paid for by employers, individuals, and/or present in countries in Asia and some other coun-
government subsidies. tries. These viruses pass readily from birds to
The main goal in health care reform is to birds and have devastated bird flocks in more
ensure that all Americans can get health coverage. than 11 countries. The infection has appeared in
Related problems include the cost of creating such humans, but most cases have resulted from con-
a system, the fact that those with insurance may tact with infected poultry or contaminated sur-
pay more to cover uninsured individuals, the lack faces. The spread from one person to another has
of freedom in choosing health care providers, and been reported only rarely. However, because the
the regulations that will have to be created to death rate for this bird flu in humans is between
establish a national health care system. 50 and 60 percent, a major concern is that the
H5N1 viruses will mutate and begin to spread
from birds to humans more readily. Even if the
PANDEMIC H5N1 viruses do not mutate and spread to
humans, WHO is still concerned about many
A pandemic exists when the outbreak of a dis- other viruses. Examples include the hantavirus
ease occurs over a wide geographic area and spread by rodents, severe acute respiratory syn-
24 CHAPTER 1
drome (SARS), monkeypox, and filoviruses such for immediate use, and more research must
as the Ebola virus and the Marburg virus that be done to develop and produce effective anti-
cause hemorrhagic fever. Because viruses are viral drugs
prone to mutation and exchanging genetic infor-
mation, the creation of a new lethal virus can ♦ Development of protective public health mea-
occur at any time. WHO estimates that 2 to 7 mil- sures: influenza must be diagnosed rapidly
lion people worldwide could die from infections and accurately, strict infection control meth-
by this type of virus. Other estimates are that tens ods must be implemented to limit the spread
of millions of people could die. of the virus, first responders and health care
Many governments are creating pandemic personnel must be immunized so they will be
influenza plans to protect their populations. able to care for infected individuals, and quar-
Components of most plans include the following: antine measures must be used if necessary to
control the spread of the disease
♦ Education: information about the pandemic
and ways to avoid its spread must be given to ♦ International cooperation: countries must be
the entire population willing to work with each other to create an
international plan that will limit the spread of
♦ Vaccine production: more research must be
lethal viruses and decrease the severity of a
directed toward producing effective vaccines
pandemic
in larger quantities and in a shorter period of
time In the near future, much effort will be directed
♦ Antiviral drugs: drugs that are currently avail- toward identifying and limiting the effect of any
able must be stockpiled so they will be ready organism that could lead to a pandemic. Health

The Food and Drug Administration regulating maggots and leeches as medical devices?
Throughout the history of health care, maggots and leeches have been used to treat
infection and encourage blood flow. Maggots clean festering, gangrenous wounds that fail
to heal. They eat the dead tissue and discharges to clean the wound and promote the growth
of new tissue. Leeches drain excess blood from tissue and encourage new circulation.
Microsurgeons, doctors who specialize in reattaching fingers, hands, and other body
appendages, have come to rely on the assistance of leeches. When microsurgeons reattach
or transplant a body part, they can usually connect arteries that bring blood to the append-
age. They find it more difficult to attach veins, which carry blood away from the appendage,
because veins are smaller and are fragile. Without a good venous supply, blood tends to col-
lect in the new attachment, clot, and in some cases, kill the tissue. To allow time for the body
to create its own veins to the new appendage, doctors apply leeches. The leeches naturally
inject the area with a chemical that includes an anticoagulant (a substance that prevents
clotting), an anesthetic, an antibiotic, and a vasodilator (a substance that dilates or enlarges
blood vessels). This chemical encourages the blood to flow quickly. The leeches drain this
blood to reduce pressure and allow veins to form.
Even though many individuals are squeamish about the use of maggots and leeches,
they have proved to be an effective method of treatment for chronic infections and micro-
surgery. The problem arises because the sources for maggots and leeches are not reliable.
For this reason, the FDA has classified maggots and leeches as medical devices. Medical
advisers have been asked to create basic guidelines to regulate how maggots and leeches are
grown, transported, sold, and disposed of after use. This will provide a safe source for this
unique method of treatment and encourage future research on the use of maggots and
leeches as methods of treatment. It may also lead to a future in which every microsurgery
has an excellent chance of success.
care workers must stay informed and be prepared 2. Trends in health care: research topics such as
to deal with the consequences of a pandemic. home health care, the Omnibus Budget Recon-
ciliation Act of 1987, telemedicine, holistic
health care, cost containment, geriatric care,
CONCLUSION and wellness to obtain additional information
on the present effect on health care.
Although the preceding are just several of the 3. Complementary/alternative methods of health
many trends in health care, they do illustrate how care: search the Internet for additional infor-
health care has changed and how it will continue mation on specific therapies such as acupunc-
to change. Every health care worker must stay ture. Refer to table 1–8 for a list of many
abreast of such changes and make every attempt different therapies.
to learn about them.
4. Pandemics: search the Internet to obtain
information on at least four (4) pandemics.
STUDENT: Go to the workbook and complete Compare and contrast the cause of each
the assignment sheet for Chapter 1, History and pandemic, the number of people infected, and
Trends of Health Care. the death rate.
REVIEW QUESTIONS
CHAPTER 1 SUMMARY
1. Name the person responsible for each of the
following events in the history of health care.
The history of health care shows that treating ill-
Briefly state how their accomplishments
ness and disease has been an important part of
contributed to the current state of health care.
every civilization. Even in ancient times, people
a. The ancient Greek who is known as the
were searching for ways to eliminate illness and
Father of Medicine
disease. Some of the early plants and herbs that
b. An artist who drew the human body during
were used to treat disease are still in use today.
the Renaissance
Computers and modern technology have caused
c. The inventor of the microscope
major changes in health care in the past century.
d. The individual who discovered roentgeno-
Many more changes are expected in the future
grams (X-rays)
as scientists continue to study the human body
e. The person who discovered penicillin
and discover the causes of illness and disease.
As health care continues to grow as an in- 2. Create a time line for the history of health care
dustry, changes and trends will occur. Issues of showing the twenty (20) events you believe had
primary importance are cost containment to the most impact on modern-day care. State
control the high cost of health care, home health why you believe these events are the most
care, care for the elderly, telemedicine, wellness important.
to prevent disease, complementary and alterna-
3. List six (6) specific ways to control the rising
tive methods (CAM) of health care, a national
cost of health care.
health care plan, and pandemic preparation.
4. You are employed in a medical office with four
doctors. Identify four (4) specific ways to
conserve energy in the office.
INTERNET SEARCHES
5. Write a brief essay describing how you main-
Use the suggested search engines in Chapter 12:4 tain physical, emotional, social, mental, and
of this textbook to search the Internet for addi- spiritual wellness. Be sure to include specific
tional information on the following topics: examples for each type of wellness.
1. History of health care: research individual 6. Review all the CAM therapies shown in table
names or discoveries such as the polio vaccine 1-8. Identify two therapies that you believe
to gain more insight into how major develop- would be beneficial. Explain why you think
ments in health care occurred. the therapies might be effective.
CHAPTER 2 Health Care
Systems
Chapter Objectives
Observe Standard
Precautions
◆ Describe at least eight types of private health
care facilities
◆ Analyze at least three government agencies
and the services offered by each
◆ Describe at least three services offered by
voluntary or nonprofit agencies
Caution ◆ Compare the basic principles of at least four
different health insurance plans
OBRA Requirement—Based ◆ Explain the purpose of organizational
on Federal Law structures in health care facilities
Math Skill
Science Skill
Career Information
Technology
Health Care Systems 27
KEY TERMS
Agency for Health Care home health care Occupational Safety and
Policy and Research hospice Health Administration
(AHCPR) hospitals (OSHA)
assisted living facilities independent living facilities optical centers
Centers for Disease Control industrial health care organizational structure
and Prevention (CDC) centers preferred provider
clinics laboratories organizations (PPOs)
dental offices long-term care facilities rehabilitation
emergency care services (LTCs or LTCFs) school health services
Food and Drug managed care TRICARE
Administration (FDA) Medicaid U.S. Department of Health
genetic counseling centers medical offices and Human Services
health departments Medicare (USDHHS)
health insurance plans Medigap voluntary agencies
Health Insurance Portability mental health Workers’ Compensation
and Accountability Act National Institutes of Health World Health Organization
(HIPAA) (NIH) (WHO)
health maintenance nonprofit agencies
organizations (HMOs)
2:1 INFORMATION HOSPITALS

Private Health Care Facilities Hospitals are one of the major types of health
Today, health care systems include the many care facilities. They vary in size and types of ser-
agencies, facilities, and personnel involved in the vice provided. Some hospitals are small and serve
delivery of health care. According to U.S. govern- the basic needs of a community; others are large,
ment statistics, health care is one of the largest complex centers offering a wide range of services
and fastest-growing industries in the United including diagnosis, treatment, education, and
States. This industry employs over 13 million research. Hospitals are also classified as private
workers in more than 200 different health careers. or proprietary (operated for profit), religious,
It attracts people with a wide range of educational nonprofit or voluntary, and government, depend-
backgrounds because it offers multiple career ing on the sources of income received by the
options. By the year 2012, employment is expected hospital.
to increase to over 15 million workers. Health care There are many different types of hospitals.
has become a 4-billion-dollar-per-day business. Some of the more common ones include:
Many different health care facilities provide
services that are a part of the industry called ♦ General hospitals: treat a wide range of condi-
health care (figure 2-1). Most private health care tions and age groups; usually provide diag-
facilities require a fee for services. In some cases, nostic, medical, surgical, and emergency care
grants and contributions help provide financial services
support for these facilities. A basic description of ♦ Specialty hospitals: provide care for special
the various facilities will help provide an under- conditions or age groups; examples include
standing of the many different types of services burn hospitals, oncology (cancer) hospitals,
included under the umbrella of the health care pediatric (or children’s) hospitals, psychiatric
industry. hospitals (dealing with mental diseases and
28 CHAPTER 1
disorders), orthopedic hospitals (dealing with

bone, joint, or muscle disease), and rehabilita-
tive hospitals (offering services such as physi-
cal and occupational therapy)
♦ Government hospitals: operated by federal,
state, and local government agencies; include
the many facilities located throughout the
world that provide care for government ser-
vice personnel and their dependents; exam-
ples are Veterans Administration hospitals
(which provide care for veterans), state psy-
chiatric hospitals, and state rehabilitation
centers
♦ University or college medical centers: provide
hospital services along with research and edu-
cation; can be funded by private and/or gov-
ernmental sources
In any type of hospital facility, a wide range of
trained health workers is needed at all levels.
LONG-TERM CARE
FACILITIES
Long-term care facilities (LTCs or LTCFs)
mainly provide assistance and care for elderly
patients, usually called residents. However, they
also provide care for individuals with disabilities
or handicaps and individuals with chronic or
long-term illness.
There are many different types of long-term
care facilities. Some of the more common ones
include:
♦ Residential care facilities (nursing homes or
geriatric homes): designed to provide basic
physical and emotional care to individuals
who can no longer care for themselves; help
individuals with activities of daily living
(ADLs), provide a safe and secure environ-
ment, and promote opportunities for social
interactions
♦ Extended care facilities or skilled care facilities:
designed to provide skilled nursing care and
rehabilitative care to prepare patients* or resi-
dents for return to home environments or
other long-term care facilities; some have sub-
acute units designed to provide services to
FIGURE 2-1 Different health care facilities.
*In some health care facilities, patients are referred to
as clients. For the purposes of this text, patient will be
used.
patients who need rehabilitation to recover areas, major retail or department stores operate
from a major illness or surgery, treatment for dental clinics. Dental services can include gen-
cancer, or treatments such as dialysis for kid- eral care provided to all age groups or specialized
ney disease or heart monitoring care offered to certain age groups or for certain
♦ Independent living and assisted living dental conditions.
facilities: allow individuals who can care for
themselves to rent or purchase an apartment
in the facility; provide services such as meals, CLINICS OR SATELLITE
housekeeping, laundry, transportation, social
events, and basic medical care (such as assist-
CENTERS
ing with medications) Clinics, also called satellite clinics or satellite
Most assisted or independent living facilities centers, are health care facilities found in many
are associated with nursing homes, extended care types of health care. Some clinics are composed
facilities, and/or skilled care facilities. This allows of a group of medical or dental doctors who share
an individual to move readily from one level of a facility and other personnel. Other clinics are
care to the next when health needs change. Many operated by private groups who provide special
long-term care facilities also offer special services care. Examples include:
such as the delivery of meals to the homes of the ♦ Surgical clinics or surgicenters: perform minor
elderly, chronically ill, or people with disabilities. surgical procedures; frequently called “one-
Some facilities offer senior citizen or adult day day” surgical centers because patients are sent
care centers, which provide social activities and home immediately after they recover from
other services for the elderly. The need for long- their operation
term care facilities has increased dramatically
because of the large increase in the number of ♦ Urgent or emergency care clinics: provide first
elderly people. Many health career opportunities aid or emergency care to ill or injured patients
are available in these facilities, and there is a ♦ Rehabilitation clinics: offer physical, occupa-
shortage of nurses and other personnel. tional, speech, and other similar therapies
♦ Specialty clinics: provide care for specific dis-
eases; examples include diabetic clinics, kid-
MEDICAL OFFICES ney dialysis centers, and oncology (cancer)
clinics
Medical offices vary from offices that are pri-
♦ Outpatient clinics: usually operated by hospi-
vately owned by one doctor to large complexes
tals or large medical groups; provide care for
that operate as corporations and employ many
outpatients (patients who are not admitted to
doctors and other health care professionals. Medi-
the hospital)
cal services obtained in these facilities can include
diagnosis (determining the nature of an illness), ♦ Health department clinics: may offer clinics
treatment, examination, basic laboratory testing, for pediatric health care, treatment of sexually
minor surgery, and other similar care. Some medi- transmitted diseases and respiratory disease,
cal doctors treat a wide variety of illnesses and age immunizations, and other special services
groups, but others specialize in and handle only ♦ Medical center clinics: usually located in col-
certain age groups or conditions. Examples of spe- leges or universities; offer clinics for various
cialities include pediatrics (infants and children), health conditions; offer care and treatment
cardiology (diseases and disorders of the heart), and provide learning experiences for medical
and obstetrics (care of the pregnant female). students
DENTAL OFFICES OPTICAL CENTERS

Dental offices vary in size from offices that are Optical centers can be individually owned by an
privately owned by one or more dentists to dental ophthalmologist or optometrist or they can be
clinics that employ a group of dentists. In some part of a large chain of stores. They provide vision
30 CHAPTER 2
examinations, prescribe eyeglasses or contact

lenses, and check for the presence of eye diseases.
EMERGENCY CARE
SERVICES
Emergency care services provide special care for
victims of accidents or sudden illness. Facilities
providing these services include ambulance ser-
vices, both private and governmental; rescue
squads, frequently operated by fire departments;
emergency care clinics and centers; emergency
departments operated by hospitals; and helicop-
ter or airplane emergency services that rapidly
transport patients to medical facilities for special
care.
LABORATORIES
Laboratories are often a part of other facilities FIGURE 2-2 Many types of health care can be
but can operate as separate health care services. provided in a patient’s home.
Medical laboratories can perform special diag-
nostic tests such as blood or urine tests. Dental palliative care, or care that provides support and
laboratories can prepare dentures (false teeth) comfort, that is directed toward allowing the per-
and many other devices used to repair or replace son to die with dignity. Psychological, social, spir-
teeth. Medical and dental offices, small hospitals, itual, and financial counseling are provided for
clinics, and many other health care facilities fre- both the patient and the family. Hospice also pro-
quently use the services provided by laboratories. vides support to the family following a patient’s
death.
HOME HEALTH CARE

MENTAL HEALTH
Home health care agencies are designed to
provide care in a patient’s home (figure 2-2). The FACILITIES
services of these agencies are frequently used by
Mental health facilities treat patients with men-
the elderly and disabled. Examples of such ser-
tal disorders and diseases. Examples of these
vices include nursing care, personal care, therapy
facilities include guidance and counseling cen-
(physical, occupational, speech, respiratory), and
ters, psychiatric clinics and hospitals, chemical
homemaking (food preparation, cleaning, and
abuse treatment centers (dealing with alcohol
other household tasks). Health departments,
and drug abuse), and physical abuse treatment
hospitals, private agencies, government agen-
centers (dealing with child abuse, spousal abuse,
cies, and nonprofit or volunteer groups can offer
and geriatric [elderly] abuse).
home care services.
HOSPICE GENETIC COUNSELING

Hospice agencies provide care for terminally ill
CENTERS
persons who usually have life expectancies of 6 Genetic counseling centers can be an inde-
months or less. Care can be provided in the per- pendent facility or located in another facility such
son’s home or in a hospice facility. Hospice offers as a hospital, clinic, or physician’s office. Genetic
counselors work with couples or individuals who for employees of the industry or business by per-
are pregnant or considering a pregnancy. They forming basic examinations, teaching accident
perform prenatal (before birth) screening tests, prevention and safety, and providing emergency
check for genetic abnormalities and birth defects, care.
explain the results of the tests, identify medical
options when a birth defect is present, and help
the individuals cope with the psychological issues
caused by a genetic disorder. Examples of genetic
SCHOOL HEALTH
disorders include Down’s syndrome and cystic SERVICES
fibrosis. Counselors frequently consult with cou-
ples prior to a pregnancy if the woman is in her School health services are found in schools
late childbearing years, has a family history of and colleges. These services provide emergency
genetic disease, or is of a specific race or nation- care for victims of accidents and sudden illness;
ality with a high risk for genetic disease. perform tests to check for health conditions such
as speech, vision, and hearing problems; pro-
mote health education; and maintain a safe and
REHABILITATION sanitary school environment. Many school health
services also provide counseling.
FACILITIES
Rehabilitation facilities are located in hospi-
tals, clinics, and/or private centers. They provide
2:2 INFORMATION
care to help patients with physical or mental dis- Government Agencies
abilities obtain maximum self-care and function.
Services may include physical, occupational, rec- In addition to the government health care facilities
reational, speech, and hearing therapy. mentioned previously, other health services are
offered at international, national, state, and local
levels. Government services are tax supported.
HEALTH MAINTENANCE Examples of government agencies include:
♦ World Health Organization (WHO): an
ORGANIZATIONS international agency sponsored by the United
Health maintenance organizations (HMOs) Nations; compiles statistics and information
are both health care delivery systems and types of on disease, publishes health information, and
health insurance. They provide total health care investigates and addresses serious health
directed toward preventive health care for a fee problems throughout the world
that is usually fixed and prepaid. Services include ♦ U.S. Department of Health and Human
examinations, basic medical services, health Services (USDHHS): a national agency that
education, and hospitalization or rehabilitation deals with the health problems in the United
services as needed. Some HMOs are operated by States
large industries or corporations; others are oper- ♦ National Institutes of Health (NIH): a divi-
ated by private agencies. They often use the ser- sion of the USDHHS; involved in research on
vices of other health care facilities including disease
medical and dental offices, hospitals, rehabilita-
tive centers, home health care agencies, clinics, ♦ Centers for Disease Control and Preven-
and laboratories. tion (CDC): another division of the USDHHS;
concerned with causes, spread, and control of
diseases in populations
INDUSTRIAL HEALTH ♦ Food and Drug Administration (FDA): a
federal agency responsible for regulating food
CARE CENTERS and drug products sold to the public
Industrial health care centers or occupa- ♦ Agency for Health Care Policy and
tional health clinics are found in large companies Research (AHCPR): a federal agency estab-
or industries. Such centers provide health care lished in 1990 to research the quality of health
32 CHAPTER 2
care delivery and identify the standards of Nonprofit agencies employ many health care
treatment that should be provided by health workers in addition to using volunteer workers to
care facilities provide services.
♦ Occupational Safety and Health Admin-
istration (OSHA): establishes and enforces
standards that protect workers from job-
2:4 INFORMATION
related injuries and illnesses Health Insurance Plans
♦ Health departments: provide health ser- The cost of health care is a major concern of
vices as directed by the U.S. Department of everyone who needs health services. Statistics
Health and Human Services (USDHHS); also show that the cost of health care is more than 15
provide specific services needed by the state percent of the gross national product (the total
or local community; examples of services amount of money spent on all goods and ser-
include immunization for disease control, vices). Also, health care costs are increasing much
inspections for environmental health and faster than other costs of living. To pay for the
sanitation, communicable disease control, costs of health care, most people rely on health
collection of statistics and records related to insurance plans. Without insurance, the cost
health, health education, clinics for health of an illness can mean financial disaster for an
care and prevention, and other services individual or family.
needed in a community Health insurance plans are offered by several
thousand insurance agencies. A common exam-
ple is Blue Cross/Blue Shield (figure 2-3). In this
2:3 INFORMATION type of plan, a premium, or a fee the individual
pays for insurance coverage, is made to the insur-
Voluntary or Nonprofit Agencies ance company. When the insured individual
Voluntary agencies, frequently called non- incurs health care expenses covered by the insur-
profit agencies, are supported by donations, ance plan, the insurance company pays for the
membership fees, fund-raisers, and federal or services. The amount of payment and the type of
state grants. They provide health services at services covered vary from plan to plan. Com-
national, state, and local levels. mon insurance terms include:
Examples of nonprofit agencies include the ♦ Deductibles: amounts that must be paid by the
American Cancer Society, American Heart Asso- patient for medical services before the policy
ciation, American Respiratory Disease Associa- begins to pay
tion, American Diabetes Association, National
Mental Health Association, Alzheimer’s Associa- ♦ Co-insurance: requires that specific percent-
tion, National Kidney Foundation, Leukemia and ages of expenses are shared by the patient and
Lymphoma Society, National Foundation of the insurance company; for example, in an 80–20
March of Dimes, and American Red Cross. Many percent co-insurance, the company pays 80
of these organizations have national offices as
well as branch offices in states and/or local com-
munities.
As indicated by their names, many such orga-
nizations focus on one specific disease or group
of diseases. Each organization typically studies
the disease, provides funding to encourage
research directed at curing or treating the dis-
ease, and promotes public education regarding
information obtained through research. These
organizations also provide special services to vic-
tims of disease, such as purchasing medical
equipment and supplies, providing treatment FIGURE 2-3 Health insurance plans help pay for
centers, and supplying information regarding the costs of health care. (Courtesy of Empire Blue
other community agencies that offer assistance. Cross/Blue Shield)
percent of covered expenses, and the patient Medicare is a federal government program
pays the remaining 20 percent that provides health care for almost all individu-
♦ Co-payment: a specific amount of money a als over the age of 65, for any person with a dis-
patient pays for a particular service, for exam- ability who has received Social Security benefits
ple, $10 for each physician visit regardless of for at least 2 years, and for any person with end-
the total cost of the visit stage renal (kidney) disease. Medicare consists of
three kinds of coverage: type A for hospital insur-
ance, type B for medical insurance, and type D
Many individuals have insurance coverage for pharmaceutical (medication) expenses. Type
through their places of employment (called A covers hospital services, care provided by an
employer-sponsored health insurance or group extended care facility or home-health care agency
insurance), where the premiums are paid by the after hospitalization, and hospice care for people
employer. In most cases, the individual also pays with a terminal illness. Type B offers additional
a percentage of the premium. Private policies are coverage for doctors’ services, outpatient treat-
also available for purchase by individuals. ments, therapy, clinical laboratory services, and
A health maintenance organization (HMO) is other health care. The individual does pay a pre-
another type of health insurance plan that pro- mium for type B coverage and also must pay an
vides a managed care plan for the delivery of initial deductible for services. In addition, Medi-
health care services. A monthly fee or premium is care pays for only 80 percent of the services; the
paid for membership, and the fee stays the same individual must either pay the balance or have
regardless of the amount of health care used. The another insurance policy to cover the expenses.
premium can be paid by an employer and/or an Medigap policies are health insurance plans
individual. Total care provided is directed toward that help pay expenses not covered by Medicare.
preventive type health care. An individual insured These policies are offered by private insurance
under this type of plan has ready access to health companies and require the payment of a pre-
examinations and early treatment and detection mium by the enrollee. Medigap policies must
of disease. Because most other types of insurance meet specific federal guidelines. They provide
plans do not cover routine examinations and pre- options that allow enrollees to choose how much
ventive care, the individual insured by an HMO coverage they want to purchase.
can therefore theoretically maintain a better state Medicaid is a medical assistance program
of health. The disadvantage of an HMO is that the that is jointly funded by the federal government
insured is required to use only HMO-affiliated and state governments but operated by individ-
health care providers (doctors, laboratories, hos- ual states. Benefits and individuals covered under
pitals) for health care. If a nonaffiliated health this program vary slightly from state to state
care provider is used instead, the insured usually because each state has the right to establish its
must pay for the care. own eligibility standards, determine the type and
A preferred provider organization scope of services, set the rate of payment for ser-
(PPO) is another type of managed care health vices, and administer its own program. In most
insurance plan usually provided by large indus- states, Medicaid pays for the health care of indi-
tries or companies to their employees. The PPO viduals with low incomes, children who qualify
forms a contract with certain health care agen- for public assistance, and individuals who are
cies, such as a large hospital and/or specific doc- physically disabled or blind. Generally, all state
tors and dentists, to provide certain types of Medicaid programs provide hospital services,
health care at reduced rates. Employees are physician’s care, long-term care services, and
restricted to using the specific hospital and/or some therapies. In some states, Medicaid offers
doctors, but the industry or company using the dental care, eye care, and other specialized ser-
PPO can provide health care at lower rates. PPOs vices.
usually require a deductible and a co-payment. If The State Children’s Health Insurance Pro-
an enrollee uses a nonaffiliated provider, the PPO gram (SCHIP) was established in 1997 to provide
may require co-payments of 40–60 percent. health care to uninsured children of working
The government also provides health insur- families who earn too little to afford private insur-
ance plans for certain groups of people. Two of ance but too much to be eligible for Medicaid. It
the main plans are Medicare and Medicaid. provides inpatient and outpatient hospital ser-
34 CHAPTER 2
vices, physician’s surgical and medical care, labo- ance increases, many employers are less willing
ratory and X-ray tests, and well-baby and to offer health care insurance. Individuals with
well-child care, including immunizations. chronic illnesses often find they cannot obtain
Workers’ Compensation is a health insur- insurance coverage if their place of employment
ance plan providing treatment for workers injured changes. This is one reason the federal govern-
on the job. It is administered by the state, and ment passed the Health Insurance Portabil-
payments are made by employers and the state. ity and Accountability Act (HIPAA) in 1996.
In addition to providing payment for needed This act has five main components:
health care, this plan also reimburses the worker
♦ Health Care Access, Portability, and Renew-
for wages lost because of on-the-job injury.
ability: limits exclusions on preexisting condi-
TRICARE, formerly called CHAMPUS (the
tions to allow for the continuance of insurance
Civilian Health and Medical Programs for the
even with job changes, prohibits discrimina-
Uniform Services) is a U.S. government health
tion against an enrollee or beneficiary based
insurance plan for all military personnel. It pro-
on health status, guarantees renewability in
vides care for all active duty members and their
multiemployer plans, and provides special
families, survivors of military personnel, and
enrollment rights for individuals who lose
retired members of the Armed Forces. The Veter-
insurance coverage in certain situations such
ans Administration provides for military veter-
as divorce or termination of employment
ans.
Managed care is an approach that has ♦ Preventing Health Care Fraud and Abuse;
developed in response to rising health care costs. Administrative Simplification, and Medical
Employers, as well as insurance companies who Liability Reform: establishes methods for pre-
pay large medical bills, want to ensure that such venting fraud and abuse and imposes sanc-
money is spent efficiently rather than wastefully. tions or penalties if fraud or abuse does occur,
The principle behind managed care is that all reduces the costs and administration of health
health care provided to a patient must have a care by adopting a single set of electronic
purpose. A second opinion or verification of need standards to replace the wide variety of for-
is frequently required before care can be pro- mats used in health care, provides strict guide-
vided. Every effort is made to provide preventive lines for maintaining the confidentiality of
care and early diagnosis of disease to avoid the health care information and the security of
high cost of treating disease. For example, rou- health care records, and recommends limits
tine physical examinations, well-baby care, for medical liability
immunizations, and wellness education to pro- ♦ Tax-Related Health Provisions: promotes the
mote good nutrition, exercise, weight control, use of medical savings accounts (MSAs) by
and healthy living practices are usually provided allowing tax deductions for monies placed in
under managed care. Employers and insurance the accounts, establishes standards for long-
companies create a network of doctors, special- term care insurance, allows for the creation of
ists, therapists, and health care facilities that prostate insurance pools, and provides tax bene-
vide care at the most reasonable cost. HMOs and fits for some health care expenses
PPOs are the main providers of managed care, ♦ Application and Enforcement of Group Health
but many private insurance companies are estab- Plan Requirements: establishes standards that
lishing health care networks to provide care to require group health care plans to offer porta-
their subscribers. As these health care networks bility, access, and renewability to all members
compete for the consumer dollar, they are of the group
required to provide quality care at the lowest pos-
sible cost. The health care consumer who is
♦ Revenue Offsets: provides changes to the Inter-
nal Revenue Code for HIPAA expenses
enrolled in a managed care plan receives quality
care at the most reasonable cost but is restricted Compliance with all HIPAA regulations was
in choice of health care providers. required by April 2004 for all health care agencies.
Health insurance plans do not solve all the These regulations have not solved all of the prob-
problems of health care costs, but they do help lems of health care insurance, but they have pro-
many people by paying for all or part of the cost vided consumers with more access to insurance
of health services. However, as the cost of insur- and greater confidentiality in regard to medical
records. In addition, standardization of electronic A sample organizational chart for a large gen-
health care records, reductions in administrative eral hospital is shown in figure 2-4. This chart
costs, increased tax benefits, and decreasing shows organization by department. Each depart-
fraud and abuse in health care have reduced ment, in turn, can have an organizational chart
health care costs for everyone. similar to the one shown for the nursing depart-
ment in figure 2-4. A sample organizational chart
for a small medical office is shown in figure 2-5.
2:5 INFORMATION The organizational structure will vary with the size
of the office and the number of people employed.
Organizational Structure In both organizational charts illustrated, the
All health care facilities must have some type of lines of authority are clearly indicated. It is impor-
organizational structure. The structure may tant for health care workers to identify and under-
be complex, as in larger facilities, or simple, as in stand their respective positions in a given facility’s
smaller facilities. Organizational structure always, organizational structure. By doing this, they will
however, encompasses a line of authority or chain know their lines of authority and understand who
of command. The organizational structure should are the immediate supervisors in charge of their
indicate areas of responsibility and lead to the work. Health care workers must always take ques-
most efficient operation of the facility. tions, reports, and problems to their immediate
Hospital Board
Medical Staff
Hospital Director
(President)
(Administrator)
Maintenance Central Business

Housekeeping Supply Office Pharmacy Dietary Nursing Laboratory Radiology Therapy Volunteers
Public Medical Social

Administration Personnel Relations Accounts Records Services Physical Occupational Recreational
Director
(Vice President)
of Nurses
Nursing Surgery Inpatient Care Emergency Clinics

Education Room
Nursing Supervisors
R.N.’s
Head or Charge
Nurses
(Unit Managers)
Patient Care Ward Clerks

Technicians L.P.N.’s R.N.’s or Volunteers
(PCTs) L.V.N.’s Unit Coordinators
FIGURE 2-4 A sample hospital organizational chart.
36 CHAPTER 2
Doctor
Office
Manager
Administrative
Assistant R.N.’s Maintenance Business Dept.
Laboratory
(Receptionist) Housekeeping Insurance
L.P.N.’s Medical
L.V.N.’s Assistants
FIGURE 2-5 A sample medical office organizational chart.

Nature as a pharmacy?
Throughout history, many medicines have been derived from natural resources. Exam-
ples include aspirin, which comes from willow bark; penicillin, which comes from fungus;
and the cancer drug Taxol, which comes from the Pacific yew tree. Recognizing this, many
scientists believe that nature is a pharmaceutical gold mine and are exploring the vast sup-
ply of materials present in the oceans and in the earth.
The National Cancer Institute (NCI) has more than 100,000 samples of plants and marine
life stored in Frederick, Maryland. Every sample is crushed into a powder and made into
extracts that can be tested against human cancer cells. In addition, small quantities of the
extracts are made available to other scientists who evaluate their effectiveness against other
conditions, such as viral diseases and infections. To date, more than 4,000 extracts have
shown promise and are being used in more advanced studies. One compound, Halichon-
drin B, labeled “yellow slimy” by researchers, appears to be effective at eliminating human
tumors. Halichondrin B is an extract taken from a deep-sea sponge found in New Zealand.
Scientists have created a synthetic version of the active component in Halichondrin B. This
component, called E7389, is currently being tested in patients with a variety of tumors. By
creating synthetic versions of the compounds, scientists are preserving natural resources
while also benefiting from them.
Other natural products are now being tested and modified. Bristol-Myers is testing Ixa-
bepilone, extracted from garden soil bacteria, in patients with advanced breast cancer.
Wyeth isolated Rapamune from soil on Easter Island and proved it is effective in preventing
kidney rejection after transplants. NCI developed a compound called prostratin from tree
bark in Samoa. Healers in Samoa used the bark to treat hepatitis. The NCI has found that it
is effective against the human immunodeficiency virus (HIV) that causes acquired immune
deficiency syndrome (AIDS). As scientists continue to explore all that nature has to offer, it
is possible they will find cures for many cancers, diseases, and infections.
supervisors, who are responsible for providing tutes of Health, Centers for Disease Control
necessary assistance. If immediate supervisors and Prevention, Food and Drug Administra-
cannot answer the question or solve the problem, tion, and Occupational Safety and Health
it is their responsibility to take the situation to the Administration.
next level in the organizational chart. It is also 3. Voluntary or nonprofit agencies: search for
important for health care workers to understand information on the purposes and activities of
the functions and goals of the organization. organizations such as the American Cancer
Society, American Heart Association, American
STUDENT: Go to the workbook and complete Respiratory Disease Association, American
the assignment sheet for Chapter 2, Health Care Diabetes Association, National Mental Health
Systems. Association, National Foundation of the March
of Dimes, and the American Red Cross.
4. Health insurance: search the Internet to find
CHAPTER 2 SUMMARY specific names of companies that are health
maintenance organizations or preferred
provider organizations. Check to see how their
Health care, one of the largest and fastest grow-
coverage for individuals is the same or how it is
ing industries in the United States, encompasses
different.
many different types of facilities that provide
health-related services. These include hospitals, 5. Government health care insurance: search the
long-term care facilities, medical and dental of- Internet to learn about benefits provided
fices, clinics, laboratories, industrial and school under Medicare, Medicaid, and the State
health services, and many others. Government Children’s Health Insurance Program.
and nonprofit or voluntary agencies also pro-
vide health care services. All health care facili-
ties require different health care workers at all REVIEW QUESTIONS
levels of training.
Many types of health insurance plans are 1. Differentiate between a private or proprietary,
available to help pay the costs of health care. religious, nonprofit or voluntary, and govern-
Insurance does not usually cover the entire cost ment type of hospital.
of care, however. It is important for consumers 2. Identify at least six (6) different types of private
to be aware of the types of coverage provided by health care facilities by stating the functions of
their respective insurance plans. the facility. Provide specific examples of the
Organizational structure is important in all care received at each facility.
health care facilities. The structure can be com-
plex or simple, but it should show a line of au- 3. Name each of the following federal agencies
thority or chain of command within the facility and briefly describe its function:
and indicate areas of responsibility. a. CDC
b. FDA
c. NIH
INTERNET SEARCHES d. OSHA
e. USDHHS
Use the suggested search engines in Chapter 12:4 f. WHO
of this textbook to search the Internet for addi- 4. What does the term deductible mean on health
tional information on the following topics: insurance policies? co-insurance? co-payment?
1. Private health care facilities: search for infor- premium?
mation on each of the specific types of facili- 5. An insurance policy has a co-payment of 70–30
ties; for example, hospitals, hospice care, or percent. If an emergency department bill is
emergency care services. $660.00, what amount will the patient have to
2. Government agencies: search for more detailed pay?
information about the activities of the World 6. Why is it important for every health care
Health Organization, U.S. Department of worker to know the organizational structure for
Health and Human Services, National Insti- his/her place of employment?
CHAPTER 3 Careers in Health
Care
Chapter Objectives
Observe Standard
Precautions
◆ Compare the educational requirements for
associate’s, bachelor’s, and master’s degrees
◆ Contrast certification, registration, and
licensure
◆ Describe at least 10 different health careers by
including a definition of the career, three
Caution
duties, educational requirements, and
employment opportunities
◆ Investigate at least one health career by writing
on Federal Law
to listed sources or using the Internet to
request additional information on the career
◆ Interpret at least 10 abbreviations used to
Math Skill
identify health care career workers
◆ Define, pronounce, and spell all key terms (see
page 3 for explanation of accent mark use)
Science Skill
Career Information
Technology
Careers in Health Care 39
KEY TERMS
admitting officers/clerks electrocardiograph (ECG) medical illustrators
art, music, dance therapists technicians medical interpreters/
associate’s degree (ee-lek"-trow-car!-dee-oh- translators
athletic trainers (ATs) graf tek-nish!-ins) medical (clinical) laboratory
audiologists electroencephalographic assistants
(EEG) technologist medical (clinical) laboratory
bachelor’s degree
(ee-lek"-troh-en-sef-ahl-oh- technicians (MLTs)
biological or medical graf!-ik tek-nahl!-oh-jist)
scientists medical (clinical) laboratory
electroneurodiagnostic technologists (MTs)
biological technician technologist (END)
biomedical (clinical) medical librarians
(ee-lek"-troh-new-roh-die-
engineer medical transcriptionists
ag-nah!-stik)
biotechnological engineer medication aides/assistants
embalmers (em-bahl!-mers)
(bioengineer) mortuary assistants
emergency medical
biomedical equipment technician (EMT) multicompetent/
technicians (BETs) multiskilled worker
endodontics
cardiovascular technologist (en!-doe-don!-tiks) nurse assistants
central/sterile supply entrepreneur occupational therapists
workers (on"trah-peh-nor!) (OTs)
certification epidemiologists occupational therapy
continuing education units assistants (OTAs)
first responder
(CEUs) ophthalmic assistants (OAs)
forensic science technician
dental assistants (DAs) ophthalmic laboratory
funeral directors
dental hygienists technicians
genetic counselors
(den!-tall hi-geen!-ists) ophthalmic medical
geriatric aides/assistants technologists (OMTs)
dental laboratory (jerry-at!-rik)
technicians (DLTs) ophthalmic technicians
health care administrators (OTs)
dentists (DMDs or DDSs)
health information (medical ophthalmologists
dialysis technicians (die- records) administrators
ahl!-ih-sis tek-nish!ins) opticians (ahp-tish!-ins)
(RAs)
dietetic assistants optometrists (ODs)
health information (medical
dietetic technicians (DTs) (ah!-tom!-eh-trists)
records) technicians
dietitians (RDs) oral surgery
health science technology
Doctor of Chiropractic (DC) education (HSTE) orthodontics
(Ky-row-prak!-tik) (or"-thow-don!-tiks)
home health care assistants
Doctor of Medicine (MD) paramedic (EMT-P)
housekeeping workers/
Doctor of Osteopathic sanitary managers patient care technicians
Medicine (DO) (PCTs)
licensed practical/vocational
(Oss-tee-ohp!-ath-ik) nurses (LPNs/LVNs) pedodontics
Doctor of Podiatric Medicine (peh"-doe-don!-tiks)
licensure (ly!-sehn-shur)
(DPM) (Poh"-dee!-ah-trik) perfusionists
massage therapists
doctorate/doctoral/doctor’s (purr-few!-shun-ists)
master’s degree
degree
medical assistants (MAs)
40 CHAPTER 3
KEY TERMS
periodontics psychiatric/mental health respiratory therapy
(peh"-ree-oh-don!-tiks) technicians technicians (RTTs)
pharmacists (PharmDs) psychiatrists social workers (SWs)
(far!-mah-sists) psychologists speech–language
pharmacy technicians (sy-koll"-oh-jists) pathologists
phlebotomists radiologic technologists surgical technologists/
physical therapists (PTs) (RTs) (ray"-dee-oh-loge!-ik technicians (STs)
physical therapist assistants tek-nahl!-oh-jists) unit secretaries/ward clerks/
(PTAs) recreational therapists (TRs) unit coordinators
physicians recreational therapy veterinarians (DVMs or
physician assistants (PAs) assistants VMDs)
process technician registered nurses (RNs) (vet"-eh-ran-air!-e-ans)
prosthodontics registration veterinary assistants
(pross"-thow-don!-tiks) respiratory therapists (RTs) veterinary technologists/
technicians (VTs)
years of work beyond a bachelor’s degree. Other

3:1 INFORMATION careers require a doctorate, doctoral, or doc-
tor’s degree, which is awarded by a college or
Introduction to Health Careers university after completion of two or more years
There are more than 250 different health care of work beyond a bachelor’s or master’s degree.
careers, so it would be impossible to discuss all of Some doctorates can require four to six years of
them in this chapter. A broad overview of a vari- additional study.
ety of careers is presented, however. A health science career cluster has been
Educational requirements for health developed by the National Consortium on Health
careers depend on many factors and Science and Technology Education (NCHSTE)
can vary from state to state. Basic preparation (figure 3-1). This cluster allows a student to see
begins in high school (secondary education) and how early career awareness and exploration pro-
should include the sciences, social studies, Eng- vide the foundation for making informed choices
lish, and mathematics. Keyboarding, computer to prepare for a career in health care. Students
applications, and accounting skills are also uti- who take required courses in middle school and
lized in most health occupations. Secondary high school have the foundation for success at
health science technology education the post-secondary level.
(HSTE) programs can prepare a student for imme-
diate employment in many health careers or for
additional education after graduation. Post-sec- CERTIFICATION,
ondary education (after high school) can include
training in a career/technical school, community REGISTRATION,
college, or university. Some careers require an
associate’s degree, which is awarded by a
AND LICENSURE
career/technical school or a community college Three other terms associated with health careers
after completion of a prescribed two-year course are certification, registration, and licensure. These
of study. Other careers require a bachelor’s are methods used to ensure the skill and compe-
degree, which is awarded by a college or univer- tency of health care personnel and to protect the
sity after a prescribed course of study that usually consumer or patient.
lasts for four or more years. In some cases, a mas- Certification means that a person has ful-
ter’s degree is required. This is awarded by a col- filled requirements of education and performance
lege or university after completion of one or more and meets the standards and qualifications estab-
and retaining licensure usually requires that a

HEALTH SCIENCE CAREER CLUSTER person complete an approved educational pro-
gram, pass a state board test, and maintain cer-
Employment in Career Specialties tain standards. Examples of licensed positions
CAREER PREPARATION include physician, dentist, physical therapist,
registered nurse, and licensed practical/voca-
POST SECONDARY
WORK PLACE
PATHWAY STANDARDS
Diagnostic Health tional nurse.
Therapeutic Informatics
Support
Biotechnology
Research and
Services ACCREDITATION
Development
For most health careers, graduation from an
PLACES OF LEARNING
PLACES OF LEARNING
accredited program is required before certifica-
CAREER ORIENTATION/PREPARATION tion, registration, and/or licensure will be granted.
WORK PLACE
HIGH SCHOOL
CLUSTER FOUNDATION STANDARDS Accreditation ensures that the program of study

Academic Safety Practices meets the established quality competency stan-
Foundation Teamwork dards and prepares students for employment in
Communications Health the health career. It is important for a student to
Systems Maintenance make sure that a technical school, college, or uni-
Practices
Employability versity offers accredited programs of study before
MIDDLE
Skills Technical Skills enrolling. Two major accrediting agencies for

Legal Information health care programs are the Commission on
Responsibilities Technology
Applications
Accreditation of Allied Health Education Pro-
Ethics grams (CAAHEP) and the Accrediting Bureau of
ELEMENTARY
CAREER EXPLORATION/ ORIENTATION Health Education Schools (ABHES). A student can

contact these agencies to determine whether an
HSTE program at a specific school is accredited.
CAREER AWARENESS
FIGURE 3-1 This cluster shows how early career

awareness and exploration can provide a foundation
CONTINUING
for making informed choices to prepare for a career EDUCATION UNITS
in health care.
Continuing education units (CEUs) are
required to renew licenses or maintain cer-
lished by the professional association or govern- tification or registration in many states (figure
ment agency that regulates a particular career. 3-2). An individual must obtain additional hours
A certificate or statement is issued by the asso- of education in the specific health career area
ciation. Examples of certified positions include during a specified period. For example, many
certified dental assistant, certified laboratory states require registered nurses to obtain 24 to 48
technician, and certified medical assistant. CEUs every 1 to 2 years to renew licenses. Health
Registration is required in some health care care workers should be aware of the state require-
careers. This is performed by a regulatory body ments regarding CEUs for their given careers.
(professional association or state board) that
administers examinations and maintains a cur-
rent list (“registry”) of qualified personnel in a EDUCATION LEVELS,
given health care area. Examples of registered
positions include registered dietitian, registered TRENDS, AND
respiratory therapist, and registered radiologic
technologist.
OPPORTUNITIES
Licensure is a process whereby a govern- Generally speaking, training for most health care
ment agency authorizes individuals to work in a careers can be categorized into four levels: pro-
given occupation. Health care careers requiring fessional, technologist or therapist, technician,
licensure can vary from state to state. Obtaining and aide or assistant, as shown in table 3-1.
42 CHAPTER 3
cardiograph (ECG) technician (who records

electrical activity of the heart) and an electroen-
cephalographic (EEG) technologist (who records
electrical activity of the brain). Another example
might involve combining the basic skills of radi-
ology, medical (clinical) laboratory, and respira-
tory therapy. At times, workers trained in one
field or occupation receive additional education
to work in a second and even third occupation. In
other cases, educational programs have been
established to prepare multicompetent workers.
Another opportunity available in many health
occupations is that of entrepreneur. An entre-
preneur is an individual who organizes, man-
ages, and assumes the risk of a business. Some
health care careers allow an individual to work as
an independent entrepreneur, while others
encourage the use of groups of cooperating indi-
viduals. Many entrepreneurs must work under
the direction or guidance of physicians or den-
tists. Because the opportunity to be self-employed
FIGURE 3-2 Continuing education units (CEUs) and to be involved in the business area of health
are required to renew licenses or maintain certifica- care exists, educational programs are including
tion or registration in many states. business skills with career objectives. A common
example is combining a bachelor’s degree in a
specific health care career with a master’s degree
A common trend in health care is the multi- in business. Some health care providers who may
competent or multiskilled worker. Because be entrepreneurial include dental laboratory tech-
of high health care costs, smaller facilities and nicians, dental hygienists, nurse practitioners,
rural areas often cannot afford to hire a specialist physical therapists, physician assistants, respira-
for every aspect of care. Therefore, workers tory therapists, recreational therapists, physicians,
are hired who can perform a variety of health dentists, chiropractors, and optometrists. Although
care skills. For example, a health care worker may entrepreneurship involves many risks and requires
be hired to perform the skills of both an electro- a certain level of education and ability, it can be an
TABLE 3-1 Education and Levels of Training

CAREER LEVEL EDUCATIONAL REQUIREMENT EXAMPLES
Professional Four or more years of college with bachelor’s, master’s, Medical doctor
or doctoral degree Dentist
Technologist Three to four years of college plus work experience, Medical (clinical) laboratory technologist
or Therapist usually bachelor’s degree and, at times, master’s Physical therapist
degree Speech therapist
Respiratory therapist
Technician Two-year associate’s degree, special health science Dental laboratory technician
technology education, or three to four years of on- Medical (clinical) laboratory technician
the-job training Surgical technician
Aide or Assistant Specific number of hours of specialized education or Dental assistant
one or more years of training combining classroom Medical assistant
and/or on-the-job training Nurse assistant
extremely satisfying choice for the individual who ♦ Health Informatics Services Cluster Standards:
is well motivated, self-confident, responsible, cre- specify the knowledge and skills required of
ative, and independent. workers in health care careers that are involved
with the documentation of patient care;
includes communicating information accu-
NATIONAL HEALTH rately within legal boundaries, analyzing
CARE SKILL STANDARDS information, abstracting and coding medical
records and documents, designing and/or
The National Health Care Skill Standards (NHCSS) implementing effective information systems,
were developed to indicate the knowledge and documenting information, and understand-
skills that are expected of health care workers pri- ing operations to enter, retrieve, and maintain
marily at entry and technical levels. The seven information
groups of standards include the following: ♦ Support (Environmental) Services Cluster
♦ Health Care Core Standards: specify the knowl- Standards: specify the knowledge and skills
edge and skills that most health care workers required of workers in health care careers that
should have; discuss an academic foundation, are involved with creating a therapeutic envi-
communication skills, employability skills, ronment to provide direct or indirect patient
legal responsibilities, ethics, safety practices, care; include developing and implementing
teamwork, information technology applica- the administration, quality control, and com-
tions, technical skills, health maintenance pliance regulations of a health care facility;
practices, and knowledge about the systems maintaining a clean and safe environment
in the health care environment through aseptic techniques; managing re-
sources; and maintaining an aesthetically
♦ Therapeutic/Diagnostic Core Standards: spec- appealing environment
ify the knowledge and skills required to focus
on direct patient care in both the therapeutic ♦ Biotechnology Research and Development
and diagnostic health care careers; include Standards: specify the knowledge and skills
health maintenance practices, patient inter- required of workers in health care careers that
action, intrateam communication, monitor- are involved in bioscience research and devel-
ing patient status, and patient movement opment; include comprehending how bio-
technology contributes to health and the
♦ Therapeutic Cluster Standards (Therapeutic quality of life, developing a strong foundation
Services): specify the knowledge and skills in math and science principles, performing
required of workers in health care careers that biotechnology techniques, understanding and
are involved in changing the health status of following laboratory protocols and principles,
the patient over time; include interacting with working with product design and develop-
patients, communicating with team members, ment, and complying with bioethical policies
collecting information, planning treatment,
implementing procedures, monitoring patient Examples of some of the health careers
status, and evaluating patient response to included in the NHCSS Clusters are shown in
treatment table 3-2. The careers listed are discussed in detail
in this chapter.
♦ Diagnostic Cluster Standards (Diagnostic Ser-
vices): specify the knowledge and skills
required of workers in health care careers that
are involved in creating a picture of the health INTRODUCTION TO
status of the patient at a single point in time;
include communicating oral and written
HEALTH CAREERS
information, assessing patient’s health status, In the following discussion of health careers, a
moving and positioning patients safely and basic description of the job duties for each career
efficiently, explaining procedures and goals, is provided. The various levels in each health care
preparing for procedures, performing diag- career are also given. In addition, tables for each
nostic procedures, evaluating test results, and career group show educational requirements, job
reporting required information outlook, and average yearly earnings.
44
CHAPTER 3
TABLE 3-2 Health Science Center Pathways

Planning, managing, and providing therapeutic services, diagnostic services, health informatics, support services, and biotechnology research and development
Pathways
Therapeutic Diagnostics Health Support Biotechnology Research

Services Services Informatics Services and Development
Sample Career Specialties/Occupations
Acupuncturist Cardiovascular technologist Admitting clerk Biomedical/clinical Biochemist

Anesthesiologist assistant Clinical lab technician Applied researcher engineer Bioinformatics associate
Art/music/dance therapist Computer tomography (CT) Community services Biomedical/clinical Bioinformatics specialist
Athletic trainer technologist specialist technician Biomedical chemist
Audiologist Cytogenetic technologist Data analyst Central services Biostatistician
Certified nursing assistant Cytotechnologist Epidemiologist Environmental health Cell biologist
Chiropractor Diagnostic medical Ethicist and safety Clinical trials research
Dental assistant/hygienist sonographer Health educator Environmental services associate
Dental lab technician Electrocardiographic (ECG) Health information coder Facilities manager Clinical trials research
Dentist technician Health information services Food service coordinator
Dietician Electronic diagnostic (EEG) Health care administrator Hospital maintenance Geneticist
Dosimetrist technologist Medical assistant engineer Lab assistant—genetics
EMT Exercise physiologist Medical biller/patient financial Industrial hygienist Lab technician
Exercise physiologist Geneticist services Materials management Microbiologist
Home health aide Histotechnologist Medical information Transport technician Molecular biologist
Kinesiotherapist Magnetic resonance (MR) technologist Pharmaceutical scientist
Licensed practical nurse technologist Medical librarian/cybrarian Quality assurance technician
Massage therapist Mammographer Patient advocate Quality control technician
Medical technologist/clinical Public health educator Regulatory affairs specialist
Medical assistant
Mortician laboratory scientist Research assistant
Occupational therapist/assistant Nuclear medicine technologist Reimbursement specialist Research associate
Ophthalmic medical personnel Nutritionist (HFMA) Research scientist
Optometrist Pathologist Risk management Toxicologist
Orthotist/prosthetist Pathology assistant Social worker
Paramedic Phlebotomist Transcriptionist
Pharmacist/pharmacy technician Positron emission tomography Unit coordinator
Physical therapist/assistant (PET) technologist Utilization manager
Physician (MD/DO) Radiologic technologist/
Physician’s assistant radiographer
Psychologist
Recreation therapist
Registered nurse
Respiratory therapist
Social worker
Speech language pathologist
Surgical technician
Veterinarian/veterinary technician
Pathway Knowledge and Skills Clusters
• Academics foundation • Communications • Systems • Employability skills • Legal responsibilities • Ethics

• Safety practices Teamwork • Health maintenance practices • Technical skills • Information technology application
From National Consortium of Health Science and Technology Education, 2005.
Careers in Health Care
45
46 CHAPTER 3
To simplify the information presented in There are many health care careers in the ther-
these tables, the highest level of education for apeutic services cluster. Some of these careers are
each career group is listed. The designations used discussed in the following information sections.
are as follows:
♦ On-the-job: training while working at a job 3:2A INFORMATION
♦ HSTE program: health science technology
education program Dental Careers
♦ Associate’s degree: two-year associate’s degree Dental workers focus on the health of the teeth
♦ Bachelor’s degree: four-year bachelor’s degree and the soft tissues of the mouth. Care is directed
toward preventing dental disease, repairing or
♦ Master’s degree: one or more years beyond a
replacing diseased or damaged teeth, and treat-
bachelor’s degree to obtain a master’s degree
ing the gingiva (gums) and other supporting
♦ Doctoral (Doctor’s) degree: doctorate with four structures of the teeth.
or more years beyond a bachelor’s degree Places of employment include private dental
It is important to note that although many offices, laboratories, and clinics; or dental depart-
health careers begin with HSTE programs, obtain- ments in hospitals, schools, health departments,
ing additional education after graduation from or government agencies.
HSTE programs allows health care workers to pro- Most dental professionals work in general
gress in career level to higher-paying positions. dentistry practices where all types of dental con-
The job outlook or expected job growth ditions are treated in people of all ages. Some,
through the year 2012 is stated in the tables as however, work in specialty areas such as the fol-
“below average,” “average,” or “above average.” lowing:
Average yearly earning is presented as a range
of income, because earnings will vary according
♦ Endodontics: treatment of diseases of the
pulp, nerves, blood vessels, and roots of the
to geographical location, specialty area, level of
teeth; often called root canal treatment
education, and work experience.
All career information presented includes a ♦ Orthodontics: alignment or straightening of
basic introduction. Because requirements the teeth
for various health care careers can vary from state ♦ Oral Surgery: surgery on the teeth, mouth,
to state, it is important for students to obtain jaw and facial bones; often called maxillofa-
information pertinent to their respective states. cial surgery
More detailed information on any given career
♦ Pedodontics: dental treatment of children
discussed can be obtained from the sources listed
and adolescents
for that occupation’s career cluster.
♦ Periodontics: treatment and prevention of
diseases of the gums, bone, and structures
3:2 INFORMATION supporting the teeth
Therapeutic Services Careers ♦ Prosthodontics: replacement of natural
teeth with artificial teeth or dentures
Therapeutic careers in health care are directed
toward changing the health status of the patient Levels of workers in dentistry include dentist,
over time. dental hygienist, dental laboratory technician,
Workers in the therapeutic services use a vari- and dental assistant (see table 3-3).
ety of treatments to help patients who are injured, Dentists (DMD or DDS) are doctors who
physically or mentally disabled, or emotionally examine teeth and mouth tissues to diagnose and
disturbed. All treatment is directed toward allow- treat disease and abnormalities; perform correc-
ing patients to function at maximum capacity. tive surgery on the teeth, gums, tissues, and sup-
Places of employment include rehabilitation porting bones; and work to prevent dental
facilities, hospitals, clinics, mental health facili- disease. They also supervise the work of other
ties, daycare facilities, long-term care facilities, dental workers. Most are entrepreneurs.
home health care agencies, schools, and govern- Dental hygienists (DHs) work under the
ment agencies. supervision of dentists. They perform prelimi-
TABLE 3-3 Dental Careers

JOB OUTLOOK AVERAGE YEARLY
OCCUPATION EDUCATION REQUIRED TO YEAR 2012 EARNINGS
Dentist (DMD or DDS) • Doctor of Dental Medicine (DMD) or Below average growth $84,000–$200,000
Doctor of Dental Surgery (DDS)
• 2 or more years additional education
for specialization
• Licensure in state of practice
Dental Hygienist • Associate’s, bachelor’s, or master’s Above average growth $39,300–$83,200
(DH) degree
Licensed Dental • Licensure in state of practice
Hygienist (LDH)
Dental Laboratory • 3–4 years on-the-job or 1–2 years Average growth $23,200–$53,600
Technician (DLT) HSTE program or associate’s or
bachelor’s degree
Certified Dental • Certification can be obtained from
Laboratory National Board for Certification in
Technician (CDLT) Dental Technology
Dental Assistant • 1–3 years on-the-job or 1–2 years in
(DA) and Certified HSTE program or associate’s degree
Dental Assistant • Licensure or registration required in Above average growth $19,900–$38,700
(CDA) most states
• Certification can be obtained from
Dental Assisting National Board
nary examinations of the teeth and mouth, re- and develop radiographs, teach preventive den-
move stains and deposits from teeth, expose and tal care, sterilize instruments, and/or perform
develop radiographs, apply cavity-preventing dental receptionist duties such as scheduling
agents such as fluorides or pit and fissure appointments and handling accounts. Their
sealants to the teeth, and perform other preven- duties may be limited by the dental practice laws
tive or therapeutic (treatment) services to help of the state in which they work.
the patient develop and maintain good dental
health. In some states, dental hygienists are
authorized to place and carve restorative materi- ADDITIONAL SOURCES
als, polish restorations, remove sutures, and/or
administer anesthesia. Dental hygienists can be
OF INFORMATION
entrepreneurs. ♦ American Dental Education Association
Dental laboratory technicians (DLTs) 1400 K Street, NW
make and repair a variety of dental prostheses Washington, DC 20005
(artificial devices) such as dentures, crowns, Internet address: www.adea.org
bridges, and orthodontic appliances according to
the specifications of dentists. Specialities include ♦ American Dental Assistants Association
dental ceramist and orthodontic technician. 35 East Wacker Drive, Suite 1730
Some dental laboratory technicians are entrepre- Chicago, IL 60601-2211
neurs. Internet address: www.dentalassistant.org
Dental assistants (DAs), working under the ♦ American Dental Association
supervision of dentists, prepare patients for 211 E. Chicago Avenue
examinations, pass instruments, prepare dental Chicago, IL 60611-2678
materials for impressions and restorations, take Internet address: www.ada.org
48 CHAPTER 3
♦ American Dental Hygienists’ Association

444 N. Michigan Avenue, Suite 3400
Chicago, IL 60611
Internet address: www.adha.org
♦ Dental Assisting National Board, Inc.
676 North Saint Clair, Suite 1880
Chicago, IL 60611
Internet address: www.danb.org
♦ National Association of Dental Laboratories
325 John Knox Road
Tallahassee, FL 32303
Internet address: www.nadl.org
♦ National Association of Advisors for the Health
Professions, Inc.
FIGURE 3-3 Emergency medical technicians
P.O. Box 1518
(EMTs) provide emergency, prehospital care to
Champaign, IL 61824-1518
victims of accidents, injuries, or sudden illness.
Internet address: www.naahp.org
3-4). Another emergency medical person is a first
♦ For information about specific tasks of a den-
responder.
tal assistant, ask your instructor for the Guide-
A first responder is the first person to arrive
line for Clinical Rotations in the Diversified
at the scene of an illness or injury. Common
Health Occupations Teacher’s Resource Kit.
examples include police officers, security guards,
Additional career information is provided in
fire department personnel, and immediate fam-
the Career Highlight Section of Chapter 18 in
ily members. The first responder interviews and
this textbook.
examines the victim to identify the illness or
cause of injury, calls for emergency medical assis-
3:2B INFORMATION tance as needed, maintains safety and infection
control at the scene, and provides basic emer-
Emergency Medical Services gency medical care. A certified first responder
(CFR) course prepares individuals by teaching
Careers airway management, oxygen administration,
Emergency medical services personnel (figure bleeding control, and cardiopulmonary resusci-
3-3) provide emergency, prehospital care to vic- tation (CPR).
tims of accidents, injuries, or sudden illnesses. Emergency medical technicians basic (EMT-
Although individuals with only basic training B) provide care for a wide range of illnesses and
in first aid do sometimes work in this field, injuries including medical emergencies, bleed-
emergency medical technician (EMT) training, fractures, airway obstruction, basic life sup-
ing is required for most jobs. Formal EMT train- port (BLS), oxygen administration, emergency
ing is available in all states and is offered by childbirth, rescue of trapped persons, and trans-
fire, police, and health departments, hospitals, porting of victims.
career/technical schools, and as a nondegree Emergency medical technician defibrillator
course in technical/community colleges and (EMT-D) is a new level of EMT-B. It allows EMT-
universities. Bs with additional training and competency in
Places of employment include fire and police basic life support to administer electrical defi-
departments, rescue squads, ambulance services, brillation to certain heart attack victims.
hospital or private emergency rooms, urgent care Emergency medical technicians intermedi-
centers, industry, emergency helicopter services, ate (EMT-I) perform the same tasks as do EMT-Bs
and the military. Some EMTs are entrepreneurs. together with assessing patients, interpreting
Emergency medical technicians sometimes serve electrocardiograms (ECGs), administering defi-
as volunteers in fire and rescue departments. brillation as needed, managing shock, using
Levels of EMT include the EMT basic, EMT intravenous equipment, and inserting esopha-
intermediate, and EMT paramedic (see table geal airways.
TABLE 3-4 Emergency Medical Services Careers

EDUCATION JOB OUTLOOK AVERAGE YEARLY
OCCUPATION REQUIRED TO YEAR 2012 EARNINGS
Emergency Medical • EMT-Intermediate plus additional 6–9 months Above average $28,400–$52,600
Technician Paramedic to 2 years (over 1,000 hours) approved growth
(EMT-P)(EMT-4) paramedic training or associate’s degree
• 6 months experience as paramedic
• State certification
• Registration by the National Registry of EMTs
(NREMT) required in most states
• Other states identify as EMT-4 and administer
their own certification examination
Emergency Medical • EMT-Basic plus additional approved training Above average $21,200–$44,300
Technician of at least 35–55 hours with clinical growth
Intermediate (EMT-I) experience
(EMT-2 and EMT-3) • State certification
• Registration by the NREMT required in some
states
• Other states identify as EMT-2 and EMT-3 and
administer their own certification examination
Emergency Medical • Usually minimum 110 hours approved EMT Above average $19,200–$35,700
Technician Basic program with 10 hours of internship in growth
(EMT-B)(EMT-1) emergency room
• State certification
• Registration by National Registry of EMTs
(NREMT) required in some states
• Other states identify as EMT-1 and administer
their own certification examination
First Responder • Minimum 40 hours of approved training Above average Salary depends on
program growth individual’s regular
• Certification can be obtained from the NREMT job
Emergency medical technicians paramedic ♦ National Highway Transportation Safety

(EMT-P) perform all the basic EMT duties Administration (NHTSA)
plus in-depth patient assessment, provision of EMS Division
advanced cardiac life support (ACLS), ECG inter- 400 7th Street SW
pretation, endotracheal intubation, drug admin- Washington, DC 20590
istration, and operation of complex equipment. Internet address: www.nhtsa.dot.gov
♦ National Registry of Emergency Medical
ADDITIONAL SOURCES Technicians
6610 Busch Boulevard
OF INFORMATION P.O. Box 29233
Columbus, OH 43229
♦ National Association of Emergency Medical Internet address: www.nremt.org
Technicians
132-A East Northside Drive
P.O. Box 1400
Clinton, MS 39060-1400
Internet address: www.naemt.org
50 CHAPTER 3
♦ Doctor of Medicine (MD): Diagnoses, treats,

3:2C INFORMATION and prevents diseases or disorders; may spe-
Medical Careers cialize as noted in table 3-6
Medical careers is a broad category encompass- ♦ Doctor of Osteopathic Medicine (DO):

ing physicians (doctors) and other individuals Treats diseases/disorders, placing special
who work in any of the varied careers under the emphasis on the nervous, muscular, and
supervision of physicians. All such careers focus skeletal systems, and the relationship between
on diagnosing, treating, or preventing diseases the body, mind, and emotions; may also
and disorders of the human body. specialize
Places of employment include private prac- ♦ Doctor of Podiatric Medicine (DPM):
tices, clinics, hospitals, public health agencies, Examines, diagnoses, and treats diseases/dis-
research facilities, health maintenance organiza- orders of the feet or of the leg below the knee
tions (HMOs), government agencies, and colleges
♦ Doctor of Chiropractic (DC): Focuses on
or universities.
ensuring proper alignment of the spine and
Levels include physician, physician assistant,
optimal operation of the nervous and muscu-
and medical assistant (see table 3-5).
lar systems to maintain health
Physicians examine patients, obtain medi-
cal histories, order tests, make diagnoses, per- Physician assistants (PAs), working under
form surgery, treat diseases/disorders, and teach the supervision of physicians, take medical histo-
preventive health. Several classifications are as ries; perform routine physical examinations and
follows: basic diagnostic tests; make preliminary diagno-
TABLE 3-5 Medical Careers

Physician • Doctoral degree Above average growth $120,000–$425,500

• 3–8 years additional postgraduate training of
internship and residency depending on
specialty selected
• State licensure
• Board certification in specialty area
Physician Assistant • 2 or more years of college and usually a Above average growth $49,800–$104,600
(PA), PAC (certified) bachelor’s degree
• 2 or more years accredited physician
assistant program with certificate, associate’s,
or bachelor’s degree
• Registration, certification, or licensure
required in all states
• Certification can be obtained from National
Commission on Certification of Physician’s
Assistants
Medical Assistant • 1–2-year HSTE program or associate’s Above average growth $18,400–$46,700
(MA), CMA (certified), degree
RMA (registered) • Certification can be obtained from American
Association of Medical Assistants (AAMA)
after graduation from CAAHEP or ABHES
accredited medical assistant program
• Registered credentials can be obtained from
American Medical Technologists (AMT)
TABLE 3-6 Medical Specialties

PHYSICIAN’S TITLE SPECIALTY
Anesthesiologist Administration of medications to cause loss of sensation or feeling during surgery or

treatments
Cardiologist Diseases of the heart and blood vessels
Dermatologist Diseases of the skin
Emergency Physician Acute illness or injury
Endocrinologist Diseases of the endocrine glands
Family Physician/Practice Promote wellness, treat illness or injury in all age groups
Gastroenterologist Diseases and disorders of the stomach and intestine
Gerontologist Diseases of elderly individuals
Gynecologist Diseases of the female reproductive organs
Internist Diseases of the internal organs (lungs, heart, glands, intestines, kidneys)
Neurologist Disorders of the brain and nervous system
Obstetrician Pregnancy and childbirth
Oncologist Diagnosis and treatment of tumors (cancer)
Ophthalmologist Diseases and disorders of the eye
Orthopedist Diseases and disorders of muscles and bones
Otolaryngologist Diseases of the ear, nose, and throat
Pathologist Diagnose disease by studying changes in organs, tissues, and cells
Pediatrician Diseases and disorders of children
Physiatrist Physical medicine and rehabilitation
Plastic Surgeon Corrective surgery to repair injured or malformed body parts
Proctologist Diseases of the lower part of the large intestine
Psychiatrist Diseases and disorders of the mind
Radiologist Use of X-rays and radiation to diagnose and treat disease
Sports Medicine Prevention and treatment of injuries sustained in athletic events
Surgeon Surgery to correct deformities or treat injuries or disease
Thoracic Surgeon Surgery of the lungs, heart, or chest cavity
Urologist Diseases of the kidney, bladder, or urinary system
ses; treat minor injuries; and prescribe and

administer appropriate treatments. Pathology
assistants, working under the supervision of
pathologists, perform both gross and micro-
scopic autopsy examinations.
Medical assistants (MAs), working under
the supervision of physicians, prepare patients
for examinations; take vital signs and medical
histories; assist with procedures and treatments;
perform basic laboratory tests; prepare and main-
tain equipment and supplies; and/or perform
secretarial–receptionist duties (figure 3-4). The
type of facility and physician determines the
kinds of duties. The range of duties is determined
by state law. Assistants working for physicians
who specialize are called specialty assistants. For
example, an assistant working for a pediatrician FIGURE 3-4 Medical assistants take vital signs
is called a pediatric assistant. and prepare patients for examinations.
52 CHAPTER 3
ADDITIONAL SOURCES 3:2D INFORMATION

OF INFORMATION Mental and Social Services
Careers
♦ American Academy of Physician Assistants
Mental services professionals focus on helping
950 N. Washington Street
people with mental or emotional disorders or
Alexandria, VA 22314–1552
those who are developmentally delayed or men-
Internet address: www.aapa.org
tally impaired. Social workers help people deal
♦ American Association of Medical Assistants with illnesses, employment, or community prob-
20 N. Wacker Drive, Suite 1575 lems. Workers in both fields try to help individu-
Chicago, IL 60606–2963 als function to their maximum capacities.
Internet address: www.aama-ntl.org Places of employment include hospitals; psy-
♦ American Chiropractic Association chiatric hospitals or clinics; home health care
1701 Clarendon Boulevard agencies; public health departments; govern-
Arlington, VA 22209 ment agencies; crisis or counseling centers; drug
Internet address: www.amerchiro.org and alcohol treatment facilities; prisons; educa-
♦ American Medical Association tional institutions; and long-term care facilities.
515 North State Street Levels of employment range from psychia-
Chicago, IL 60610 trist (a physician), who diagnoses and treats men-
Internet address: www.ama-assn.org tal illness, to psychologist and psychiatric
technician. There are also various levels (includ-
♦ American Osteopathic Association ing assistant) employed in the field of social work
142 East Ontario Street (see table 3-7).
Chicago, IL 60611 Psychiatrists are physicians who specialize
Internet address: www.osteopathic.org in diagnosing and treating mental illness. Some
♦ American Podiatric Medical Association specialties include child or adolescent psychia-
9312 Old Georgetown Road try, geriatric psychiatry, and drug/chemical
Bethesda, MD 20814–1621 abuse.
Internet address: www.apma.org Psychologists study human behavior and
♦ American Society of Podiatric Medical use this knowledge to help individuals deal with
Assistants problems of everyday living. Many specialize in
2124 S. Austin Boulevard specific aspects of psychology, which include
Cicero, IL 60804 child psychology, adolescent psychology, geriat-
Internet address: www.aspma.org ric psychology, behavior modification, drug/
chemical abuse, and physical/sexual abuse.
♦ Registered Medical Assistants of the American Psychiatric/mental health technicians,
Medical Technologists working under the supervision of psychiatrists or
710 Higgins Road psychologists, help patients and their families
Park Ridge, IL 60068 follow treatment and rehabilitation plans. They
Internet address: www.amt1.org provide understanding and encouragement,
♦ For information about specific tasks of a med- assist with physical care, observe and report
ical assistant, ask your instructor for the behavior, and help teach patients constructive
Guideline for Clinical Rotations in the Diversi- social behavior. Assistants or aides who have
fied Health Occupations Teacher’s Resource Kit. completed one or more years in an HSTE pro-
Additional career information is provided in gram are also employed in this field.
the Career Highlight Section of Chapter 20 in Social workers, also called sociologists, case
this textbook. managers, or counselors (figure 3-5), aid people
TABLE 3-7 Mental and Social Services Careers

Psychiatrist • Doctoral degree Average growth $95,500–$297,000

• 2–7 years postgraduate specialty training
• State licensure
• Certification in psychiatry
Psychologist PsyD • Bachelor’s or master’s degree Above average growth $34,900–$97,800
(Doctor of • Doctor of psychology required for many or $45,900–
Psychology) positions $136,500 with
• Licensure or certification required in all doctorate
states
• Certification for specialty areas available
from American Board of Professional
Psychology
Psychiatric/Mental • Associate’s degree Average growth $28,500–$52,600
Health Technicians • Licensure required in some states
• A few states require a nursing degree
Social Workers/ • Bachelor’s or master’s degree or Doctor of Above average growth $33,500–$76,800
Sociologists Philosophy or Social Work (DSW)
• Licensure, certification or registration
required in all states
• Credentials available from National
Association of Social Workers
Genetic Counselor • Master’s degree Above average growth $38,900–$97,600
(GC) • Certification can be obtained from the
American Board on Genetic Counseling
who have difficulty coping with various problems

by helping them make adjustments in their lives
and/or by referring them to community resources
for assistance. Specialties include child welfare,
geriatrics, family, correctional (jail), and occupa-
tional social work. Many areas employ assistants
or technicians who have one or more years of an
HSTE program.
Genetic counselors provide information to
individuals and families on genetic diseases or
inherited conditions. They research the risk for
occurrence of the disease or birth defect, analyze
inheritance patterns, perform screening tests
FIGURE 3-5 Social workers help people make life for potential genetic defects, identify medical
adjustments and refer patients to community options when a genetic disease or birth defect is
resources for assistance. present, and help individuals cope with the psy-
54 CHAPTER 3
chological issues caused by genetic diseases. ♦ National Mental Health Association

Genetic counselors may specialize in prenatal 2001 N. Beauregard Street
(before birth) counseling, pediatric (child) coun- Alexandria, VA 22311
seling, neurogenetics (brain and nerves), cardio- Internet address: www.nmha.org
genetics (heart and blood vessels), or genetic
influences on cancer.
3:2E INFORMATION
ADDITIONAL SOURCES Mortuary Careers
OF INFORMATION Workers in mortuary careers provide a service
that is needed by everyone. Even though funeral
♦ American Board of Genetic Counseling practices and rites vary because of cultural diver-
9650 Rockville Pike sity and religion, most services involve prepara-
Bethesda, MD 20814 tion of the body, performance of a ceremony that
Internet address: www.abgc.net honors the deceased and meets the spiritual
needs of the living, and cremation or burial of the
♦ American Psychiatric Association remains.
1000 Wilson Boulevard, Suite 1825 Places of employment are funeral homes or
Arlington, VA 22209-3901 mortuaries, crematoriums, or cemetery associa-
Internet address: www.psych.org tions.
♦ American Psychological Association Levels include funeral director, embalmer,
750 1st Street NE and mortuary assistant (see table 3-8).
Washington, DC 20002-4242 Funeral directors, also called morticians
Internet address: www.apa.org or undertakers, provide support to the survivors;
♦ American Sociological Association interview the family of the deceased to establish
1307 New York Avenue NW, Suite 700 details of the funeral ceremonies or review
Washington, DC 20005 arrangements the deceased person requested
Internet address: www.asanet.org prior to death; prepare the body following legal
requirements; secure information for legal docu-
♦ National Mental Health Information Center ments; file death certificates; arrange and direct
P.O. Box 42557 all the details of the wake and services; make
Washington, DC 20015 arrangements for burial or cremation; and direct
Internet address: www.mentalhealth.org all business activities of the funeral home. Fre-
♦ National Association of Social Workers quently, funeral directors help surviving individ-
750 First Street NE, Suite 700 uals adapt to the death by providing post-death
Washington, DC 20002-4241 counseling and support group activities. Most
Internet address: www.naswdc.org funeral directors are also licensed embalmers.
TABLE 3-8 Mortuary Careers

Funeral Director
(Mortician) • 2–4 years in a mortuary science college or associate’s Average growth $28,600–$94,700
• Licensure required in all states except Colorado
Embalmer • 2–4 years in a mortuary science college or associate’s Average growth $22,600–$71,500
• Licensure required in all states except Colorado
Mortuary Assistant • 1–2 years on-the-job training or 1-year HSTE program Average growth $14,500–$26,800
Embalmers prepare the body for interment ♦ International Conference of Funeral Service
by washing the body with germicidal soap, replac- Examining Boards
ing the blood with embalming fluid to preserve 1885 Shelby Lane
the body, reshaping and restructuring disfigured Fayetteville, AR 72704
bodies, applying cosmetics to create a natural Internet address: www.cfseb.org
appearance, dressing the body, and placing it in a
casket. They are also responsible for maintaining
♦ National Funeral Directors Association
13625 Bishop’s Drive
embalming reports and itemized lists of clothing
Brookfield, WI 53005
or valuables.
Internet address: www.nfda.org
Mortuary assistants work under the super-
vision of the funeral director and/or embalmer.
They may assist with preparation of the body, 3:2F INFORMATION
drive the hearse to pick up the body after death or
to take it to the burial site, arrange flowers for the Nursing Careers
viewing, assist with preparations for the funeral Those in the nursing careers provide care for
service, help with filing and maintenance of patients as directed by physicians. Care focuses
records, clean the funeral home, and other simi- on the mental, emotional, and physical needs of
lar duties. the patient.
Hospitals are the major places of employ-
ment, but nursing workers are also employed in
ADDITIONAL SOURCES long-term care facilities, rehabilitation centers,
physicians’ offices, clinics, public health agencies,
OF INFORMATION home health care agencies, health maintenance
organizations (HMOs), schools, government
♦ American Board of Funeral Service Education agencies, and industry.
38 Florida Avenue Levels include registered nurse, licensed
Portland, ME 04103 practical/vocational nurse, and nurse assistant/
Internet address: www.abfse.org technician (see table 3-9).
TABLE 3-9 Nursing Careers

Registered Nurse (RN) • 2–3-year diploma program in hospital school Above average $36,500–$84,600
of nursing, or associate’s degree or bachelor’s growth
degree
• Master’s or doctoral for some administrative/ $60,300–
educational positions and for some advanced $108,900 with
practice nursing positions advanced
• Licensure in state of practice specialities
Licensed Practical/ • 1–2-year state-approved HSTE practical/ Above average $25,800–$52,600
Vocational Nurse vocational nurse program growth
(LPN/LVN) • Licensure in state of practice
Nurse Assistant • HSTE program Above average $14,900–$29,200
Geriatric Aide • Certification or registration required in all growth especially
Home Health Care states for long-term care facilities— in geriatric or
Assistant obtained by completing 75–120-hour home care
Medication Aide state-approved program
Certified Nurse Technician
Patient Care Technician
(PCT)
56 CHAPTER 3
Registered nurses (RNs) (figure 3-6), work ♦ Nurse educators: teach in HSTE programs,
under the direction of physicians and provide schools of nursing, colleges and universities,
total care to patients. The RN observes patients, wellness centers, and health care facilities
assesses patients’ needs, reports to other health
care personnel, administers prescribed medica- ♦ Nurse anesthetists: administer anesthesia,
tions and treatments, teaches health care, and monitor patients during surgery, and assist
supervises other nursing personnel. The type of anesthesiologists (who are physicians)
facility determines specific job duties. Registered ♦ Clinical nurse specialists (CNSs): use advanced
nurses with an advanced education can special- degree to specialize in specific nursing areas
ize. Examples of advanced practice nurses such as intensive care, trauma or emergency
include: care, psychiatry, pediatrics (infants and chil-
♦ Nurse practitioners (CRNPs): take health histo- dren), neonatology (premature infants), and
ries, perform basic physical examinations, gerontology (elderly individuals)
order laboratory tests and other procedures,
Licensed practical/vocational nurses
refer patients to physicians, help establish
(LPNs/LVNs), working under the supervision of
treatment plans, treat common illnesses such
physicians or RNs, provide patient care requiring
as colds or sore throats, and teach and pro-
technical knowledge but not the level of educa-
mote optimal health
tion required of RNs. The type of care is deter-
♦ Nurse midwives (CNMs): provide total care for mined by the work environment, which can
normal pregnancies, examine the pregnant include the home, hospital, long-term care facil-
woman at regular intervals, perform routine ity, adult daycare center, physician’s office, clinic,
tests, teach childbirth and childcare classes, wellness center, and health maintenance organi-
monitor the infant and mother during child- zation. Care provided by LPN/LVNs is also deter-
birth, deliver the infant, and refer any prob- mined by state laws regulating the extent of
lems to a physician duties.
Nurse assistants (also called nurse aides,
nurse technicians, patient care technicians
(PCTs), or orderlies) work under the supervision
of RNs or LPNs/LVNs. They provide patient care
such as baths, bedmaking, and feeding; assist in
transfer and ambulation; and administer basic
treatments. Geriatric aides/assistants acquire
additional education to provide care for the
elderly in work environments such as extended
care facilities, nursing homes, retirement centers,
adult daycare agencies, and other similar agen-
cies. Home health care assistants are trained
to work in the patient’s home and may perform
additional duties such as meal preparation or
cleaning. Medication aides/assistants receive
special training such as a 40-hour or more state-
approved medication aide course to administer
medications to patients or residents in long-term
care facilities or patients receiving home health
care. Most states that have the medication aide
program require that the aide be on the state-
approved list for nurse or geriatric assistants
before taking the medication aide course. In addi-
tion, many states require a competency test.
Each nursing assistant working in a long-
FIGURE 3-6 Registered nurses (RNs) administer term care facility or home health care is now
prescribed medications to patients. required under federal law to complete a manda-
tory, state-approved training program and pass a

written and/or competency examination to 3:2G INFORMATION
obtain certification or registration. Health work-
ers in these environments should check the
Nutrition and Dietary Services
requirements of their respective states. Careers
Health, nutrition, and physical fitness have
become a way of life. Workers employed in the
nutrition and dietary services recognize the
ADDITIONAL SOURCES importance of proper nutrition to good health.
OF INFORMATION Using knowledge of nutrition, they promote well-
ness and optimum health by providing dietary
guidelines used to treat various diseases, teach-
♦ American College of Nurse Practitioners ing proper nutrition, and preparing foods for
1111 19th Street NW, Suite 404
health care facilities.
Washington, DC 20036
Places of employment include hospitals,
Internet address: www.acnpweb.org
long-term care facilities, child and adult daycare
♦ American Health Care Association facilities, wellness centers, schools, home health
1201 L Street NW care agencies, public health agencies, clinics,
Washington, DC 20005 industry, and offices.
Internet address: www.ahca.org Levels include dietitian, dietetic technician,
♦ American Nurses’ Association and dietetic assistant (see table 3-10).
8515 Georgia Avenue, Suite 400 Dietitians (RDs) or nutritionists (figure 3-7)
Silver Spring, MD 20910 manage food service systems, assess patients’/
Internet address: www.nursingworld.org residents’ nutritional needs, plan menus, teach
others proper nutrition and special diets, research
♦ National Association for Home Care and
nutrition needs and develop recommendations
Hospice
based on the research, purchase food and equip-
228 Seventh Street SE
Internet address: www.nahc.org
♦ National Association for Practical Nurse
Education and Service
P.O. Box 25647
Alexandria, VA 22313
Internet address: www.napnes.org
♦ National Federation of Licensed Practical
Nurses
605 Poole Drive
Garner, NC 27529
Internet address: www.nflpn.org
♦ National League for Nursing
61 Broadway
New York, NY 10006
Internet address: www.nln.org
♦ For information about specific tasks of a geri-
atric assistant/technician or nurse assistant/
technician, ask your instructor for the Guide-
line for Clinical Rotations in the Diversified
Health Occupations Teacher’s Resource Kit.
Additional career information is provided in FIGURE 3-7 Dietitians manage food service
the Career Highlight Section of Chapter 21 in systems, assess nutritional needs, and plan menus
this textbook. according to prescribed diets.
58 CHAPTER 3
TABLE 3-10 Nutrition and Dietary Services Careers

Dietitian, RD • Bachelor’s or master’s degree Average growth $32,700–$68,300

(registered) • Registration can be obtained from Commission on
Dietetic Registration of the American Dietetic
Association
• Licensure, certification, or registration required in
many states
Dietetic Technician, • Associate’s degree Average growth $24,200–$49,200
DTR (registered) • Licensure, certification, or registration required in
some states
• Registration can be obtained from the Commission on
Dietetic Registration
Dietetic Assistant • 6–12 months on the job Average growth $13,600–$24,900
• One or more years HSTE or food service career/
technical program
ment, enforce sanitary and safety rules, and Chicago, IL 60607

supervise and/or train other personnel. Some Internet address: www.ift.org
dietitians specialize in the care of pediatric
(child), renal (kidney), or diabetic patients, or in
♦ For information about specific tasks of a
dietary assistant/food service worker, ask your
weight management.
instructor for the Guideline for Clinical Rota-
Dietetic technicians (DTs), working under
tions in the Diversified Health Occupations
the supervision of dietitians, plan menus, order
Teacher’s Resource Kit.
foods, standardize and test recipes, assist with
food preparation, provide basic dietary instruc-
tion, and teach classes on proper nutrition. 3:2H INFORMATION
Dietetic assistants, also called food service
workers, work under the supervision of dietitians Veterinary Careers
and assist with food preparation and service, help Veterinary careers focus on providing care to all
patients select menus, clean work areas, and types of animals—from house pets to livestock to
assist other dietary workers. wildlife.
Places of employment include animal hospi-
tals, veterinarian offices, laboratories, zoos, farms,
ADDITIONAL SOURCES animal shelters, aquariums, drug or animal food
OF INFORMATION companies; and fish and wildlife services.
Levels of employment include veterinarian,
♦ American Dietetic Association animal health technician, and assistant (see table
120 South Riverside Plaza, Suite 2000 3-11).
Chicago, IL 60606-6995 Veterinarians (DVMs or VMDs) (figure 3-8)
Internet address: www.eatright.org work to prevent, diagnose, and treat diseases and
injuries in animals. Specialties include surgery,
♦ Dietary Managers Association small-animal care, livestock, fish and wildlife,
406 Surrey Woods Drive and research.
St. Charles, IL 60174 Veterinary technologists/technicians
Internet address: www.dmaonline.org (VTs), also called animal health technicians, work-
♦ Institute of Food Technologists ing under the supervision of veterinarians, assist
525 West Van Buren, Suite 1000 with the handling and care of animals, collect
TABLE 3-11 Veterinary Careers

Veterinarian • 3–4 years preveterinary college Above average $45,300–$125,900

(DVM or VMD) • 4 years veterinary college and Doctor of growth
Veterinary Medicine degree
• State licensure required in all states
Veterinary • Associate’s degree for veterinary technician Above average $20,200–$61,800
(Animal Health) • Bachelor’s degree for veterinary technologist growth
Technologist/Technician • Registration, certification, or licensure required in
VTR (registered) most states
• Certification for technologists/technicians
employed in animal laboratory research facilities
can be obtained from the American Association for
Laboratory Animal Science (AALAS)
Veterinary Assistant • 1–2 years on the job or 1–2-year HSTE program Above average $15,200–$35,300
(Animal Caretakers) growth
specimens, assist with surgery, perform laboratory

tests, take and develop radiographs, administer
prescribed treatments, and maintain records.
Veterinary assistants, also called animal
caretakers, feed, bathe, and groom animals; exer-
cise animals; prepare animals for treatment;
assist with examinations; clean and sanitize
cages, examination tables, and surgical areas;
and maintain records.
ADDITIONAL SOURCES
OF INFORMATION
♦ American Association for Laboratory
Animal Science
9190 Crestwyn Hills Drive
Memphis, TN 38125
Internet address: www.aalas.org
♦ American Veterinary Medical Association
1931 N. Meacham Road, Suite 100
Schaumburg, IL 60173-4360
Internet address: www.avma.org
♦ Animal Caretakers Information
The Humane Society of the United States FIGURE 3-8 Veterinarians work to prevent,
2100 L Street NW diagnose, and treat diseases and injuries in ani-
Washington, DC 20037 mals. (Courtesy Warren, Small Animal Care and
Internet address: www.hsus.org Management, 1995, Delmar Learning)
60 CHAPTER 3
♦ North America Veterinary Technician Associa- stores, hospitals, schools, health maintenance
tion (NAVTA) organizations (HMOs), government agencies,
P. O. Box 224 and clinics.
Battle Ground, IN 47920 Levels include ophthalmologist, optometrist,
Internet address: www.navta.net ophthalmic medical technologist, ophthalmic
technician, opthalmic assistant, optician, and
♦ For information about specific tasks of a vet- ophthalmic laboratory technician (see table 3-12).
erinary assistant, ask your instructor for the
Many individuals in this field are entrepreneurs.
Guideline for Clinical Rotations in the Diversi-
Ophthalmologists are medical doctors
fied Health Occupations Teacher’s Resource
specializing in diseases, disorders, and injuries of
Kit.
the eyes. They diagnose and treat disease, per-
form surgery, and correct vision problems or
3:2I INFORMATION defects.
Optometrists (ODs), doctors of optometry,
Vision Services Careers examine eyes for vision problems and defects,
Workers in the vision services provide care to pre- prescribe corrective lenses or eye exercises, and
vent and treat vision disorders. Places of employ- in some states, use drugs for diagnosis and/or
ment include offices, optical shops, department treatment. If eye disease is present or if eye sur-
TABLE 3-12 Vision Services Careers

Opthalmologist • Doctoral degree Average growth $108,000–$248,500

(MD) • 2–7 years postgraduate specialty training
• State licensure
• Certification in ophthalmology
Optometrist (OD) • 3–4 years preoptometric college Average growth $62,300–$125,300
• Four years at college of optometry for doctor of
optometry degree
• State licensure
Ophthalmic Medical • Associate’s or bachelor’s degree Average growth $28,600–$68,500
Technologist • Certification can be obtained from the Joint
COMT (certified) Commission on Allied Health Personnel in
Ophthalmology (JCAHPO)
Ophthalmic Technician • Associate’s degree Average growth $27,500–50,200
COT (certified) • Certification can be obtained from JCAHPO
Ophthalmic Assistant • Some on-the-job training Average growth $14,900–31,500
COA (certified) • One month to 1-year HSTE program
• Certification can be obtained from the JCAHPO
Optician • 2–4 years on the job or 2–4-year apprenticeship Average growth $19,400–$46,500
or HSTE program or associate’s degree
• Licensure or certification required in some states
• Certification can be obtained from Amercian
Board of Opticianry and National Contact Lens
Examiners
Ophthalmic • 2–3 years on the job or 1-year HSTE certificate Below average $15,400–$35,600
Laboratory program growth
Technician
gery is needed, the optometrist refers the patient Opticians make and fit the eyeglasses or
to an ophthalmologist. lenses prescribed by ophthalmologists and
Ophthalmic medical technologists optometrists. Some specialize in contact lenses.
(OMTs), working under the supervision of opthal- Ophthalmic laboratory technicians cut,
mologists, obtain patient histories, perform rou- grind, finish, polish, and mount the lenses used
tine eye tests and measurements, fit patients for in eyeglasses, contact lenses, and other optical
contacts, administer prescribed treatments, instruments such as telescopes and binoculars.
assist with eye surgery, perform advanced diag-
nostic tests such as ocular motility and biocular
function tests, administer prescribed medica- ADDITIONAL SOURCES
tions, and perform advanced microbiological
procedures. In addition, they may perform any OF INFORMATION
tasks that ophthalmic technicians or assistants
perform. ♦ American Optometric Association
Ophthalmic technicians (OTs) (figure 3-9) 243 N. Lindbergh Boulevard
work under the supervision of ophthalmologists St. Louis, MO 63141
and optometrists. Technicians prepare patients Internet address: www.aoanet.org
for examinations, obtain medical histories, take ♦ Association of Schools and Colleges of
ocular measurements, administer basic vision Optometry
tests, maintain ophthalmic and surgical instru- 6110 Executive Boulevard, Suite 510
ments, adjust glasses, teach eye exercises, measure Rockville, MD 20852
for contacts, instruct patients on the care and use Internet address: www.opted.org
of contacts, and perform receptionist duties. ♦ Commission on Opticianry Accreditation
Ophthalmic assistants (OAs) work under 8665 Sudley Road, Suite 341
the supervision of ophthalmologists, optome- Manassas, VA 20110
trists, and/or ophthalmic medical technologists Internet address: www.coaccreditation.com
or technicians. Assistants prepare patients for
examinations, measure visual acuity, perform ♦ Joint Commission on Allied Health Personnel
receptionist duties, help patients with frame in Ophthalmology
selections and fittings, order lenses, perform 2025 Woodlane Drive
minor adjustments and repairs of glasses, and St. Paul, MN 55125-2995
teach proper care and use of contact lenses. Internet address: www.jcahpo.org
♦ National Federation of Opticianry Schools
1238 Robinson Point Road
Mountain Home, AR 72653
Internet address: ww.nfos.org
♦ Opticians Association of America
441 Carlisle Drive
Herndon, VA 20170
Internet address: www.oaa.org
3:2J INFORMATION
Other Therapeutic Services
Careers
There are many other therapeutic service careers.
Some are discussed in this section. Most thera-
FIGURE 3-9 Ophthalmic technicians perform peutic occupations include levels of therapist,
basic vision tests and teach eye exercises. (Cour- technician, and assistant/aide (see table 3-13).
tesy of the American Optometric Association, St. Occupational therapists (OTs) (figure
Louis, MO) 3-10) often work under the direction of a physia-
62 CHAPTER 3
TABLE 3-13 Other Therapeutic Services Careers

Occupational Therapist • Master’s degree and internship Above average

(OT) OTR (registered) • Licensure required in all states growth $43,900–$93,600
• Certification can be obtained from American
Occupational Therapy Association
Occupational Therapy • Associate’s degree or certificate and internship Above average $32,500–$56,600
Assistant • Licensure or certification required by most states growth
COTA (certified) • Certification can be obtained from American
Occupational Therapy Association
Pharmacist • 5–6-year college program with Doctor of Above average $56,800–$103,500
(PharmD) Pharmacy degree plus internship growth
• Licensure required in all states
Pharmacy • 1 or more years on the job or 1–2-year HSTE Above average $17,300–$36,400
Technician program or associate’s degree growth
• Licensure required in many states
• Certification can be obtained from the Pharmacy
Technician Certification Board
Physical Therapist • Master’s or doctoral degree Above average $48,400–$108,300
(PT) • Licensure required in all states growth
Physical Therapist • Associate’s degree plus internship Above average $23,500–$54,900
Assistant (PTA) • Licensure required in most states growth
Massage Therapist • 3-month to 1-year accredited Massage Therapy Above average $22,400–$46,500
Program growth
• Certification, registration, or licensure required in
many states
• Certification can be obtained from the National
Certification Board for Therapeutic Massage and
Bodywork (NCBTMB)
Recreational Therapist • Possibly associate’s but usually bachelor’s degree Average growth $26,800–$54,500
(TR) plus internship
Certified Therapeutic • Licensure or certification required in a few states
Recreation Specialist • Certification can be obtained from National
(CTRS) Council for Therapeutic Recreation Certification
(NCTRC)
• Registration can be obtained from Association for
Rehabilitation Therapy
Recreational Therapist • 1–2-year HSTE certificate program or associate’s Average growth $14,700–$32,800
Assistant (Activity degree
Director) • Certification can be obtained from National
Council for Therapeutic Recreation Certification
Respiratory Therapist, • Associate’s or bachelor’s degree Above average $32,800–$66,300
RTRRT (registered) • Licensure required in most states growth
• Registration can be obtained from National Board
for Respiratory Care
Respiratory Therapy • 1–2-year HSTE program or associate’s degree Above average $23,400–$49,800
Technician (RTT) • Licensure or certification required in most states growth
CRTT (certified) • Certification can be obtained from National Board
for Respiratory Care
(continued)
TABLE 3-13 Other Therapeutic Services Careers (Continued)
Speech–Language • Master’s degree and 9 months postgraduate Above average $40,100–$82,500

Therapist/Pathologist clinical experience growth
and/or Audiologist • Licensure required in most states
• Clinical doctoral degree common for audiologists
• Audiologists may obtain certification from the
American Board of Audiology
• Certificate of Clinical Competence in Speech–
Language Pathology (CCC–SLP) or Audiology
(CCC–A) can be obtained from American
Speech-Language-Hearing Association (ASHA)
Surgical Technician/ • 1–2-year HSTE program Above average $24,800–$48,500
Technologist • Certificate, diploma, or associate’s degree growth
CST (certified) • Certification can be obtained from Liaison
Council on Certification for Surgical
Technologists
Art, Music, Dance • Bachelor’s or master’s degree Average growth $25,700–$64,500
Therapist • Certification for art therapist can be obtained
from American Art Therapy Association
• Registration for music therapist can be obtained
from National Association of Music Therapy
and American Association for Music Therapy
• Registration for dance therapist (DTR) can be
obtained from American Dance Therapy
Association
• Registration for art therapist (ATR) can be
obtained from the Art Therapy Credentials Board
Athletic Trainer ATC • Bachelor’s or master’s degree Above average $35,000–$73,800
(certified) • Licensure required in some states growth
• Most states require certification
Athletic Trainers Association
Dialysis Technician • Varies with states Average growth $18,700–$56,800
• Some states require RN or LPN license and
state-approved dialysis training
• Other states require 1–2-year HSTE state-
approved dialysis program or associate’s degree
Association of Nephrology Technicians/
Technologists
Perfusionist • Bachelor’s degree Above average $51,600–$112,800
Certified Clinical • Specialized extracorporeal circulation training growth
Perfusionist (CCP) and supervised clinical experience
Extracorporeal • Licensure required in some states
Circulation • Certification can be obtained from American
Technologist Board of Cardiovascular Perfusion
64 CHAPTER 3
FIGURE 3-11 Pharmacists dispense medications

and provide information on drugs. (Courtesy of the
FIGURE 3-10 Occupational therapists (OTs) help Michigan Pharmacists Association and the Michigan
patients with disabilities to overcome, correct, or Society of Pharmacy Technicians)
adjust to the disabilities.
trist, a physician specializing in physical medi- fessionals authorized to prescribe medications.

cine and rehabilitation. OTs help people with They provide information on drugs and correct
physical, developmental, mental, or emotional ways to use them; order and dispense other
disabilities to overcome, correct, or adjust to their health care items such as surgical and sickroom
particular problems. The occupational therapist supplies; recommend nonprescription items to
uses various activities to assist the patient in customers/patients; ensure drug compatibility;
learning skills or activities of daily living (ADL), maintain records on medications dispensed; and
adapting job skills, or preparing for return to assess, plan, and monitor drug usage. Pharma-
work. Treatment is directed toward helping cists can also either be entrepreneurs or work for
patients acquire independence, regain lost func- one of the many drug manufacturers involved in
tions, adapt to disabilities, and lead productive researching, manufacturing, and selling drugs.
and satisfying lives. Pharmacy technicians, working under the
Occupational therapy assistants (OTAs), supervision of pharmacists, help prepare medi-
working under the guidance of occupational cations for dispensing to patients, label medica-
therapists, help patients carry out programs of tions, perform inventories and order supplies,
prescribed treatment. They direct patients in arts prepare intravenous solutions, help maintain
and crafts projects, recreation, or social events; records, and perform other duties as directed by
teach and help patients carry out rehabilitation pharmacists.
activities and exercises; use games to develop Physical therapists (PTs) (figure 3-12)
balance and coordination; assist patients trying often work under the direction of a physiatrist, a
to master the activities of daily living; and inform physician specializing in physical medicine and
therapists of patients’ responses and progress. rehabilitation. PTs provide treatment to improve
Pharmacists (PharmDs) (figure 3-11) dis- mobility and prevent or limit permanent disabil-
pense medications per written orders from ity of patients with disabling joint, bone, muscle,
physicians, dentists, and other health care pro- and/or nerve injuries or diseases. Treatment may
or inflammatory diseases, improve lymphatic

circulation to decrease edema (swelling), and
relieve stress and tension. Some massage thera-
pists are entrepreneurs.
Recreational therapists (TRs), or thera-
peutic recreation specialists, use recreational and
leisure activities as forms of treatment to mini-
mize patients’ symptoms and improve physical,
emotional, and mental well-being. Activities
might include organized athletic events, dances,
arts and crafts, musical activities, drama, field
trips to shopping centers or other places of inter-
est, movies, or poetry or book readings. All activi-
ties are directed toward allowing the patient to
gain independence, build self-confidence, and
relieve anxiety. Some recreational therapists are
entrepreneurs.
Recreational therapy assistants, also
called activity directors, work under the supervi-
sion of recreational therapists or other health
care professionals. They assist in carrying out the
activities planned by therapists and, at times,
FIGURE 3-12 Physical therapists (PTs) provide arrange activities or events. They note and inform
treatment to improve mobility of patients with therapists of patients’ responses and progress.
disabling injuries or diseases. Respiratory therapists (RTs), under phy-
sicians’ orders, treat patients with heart and lung
diseases by administering oxygen, gases, or med-
include exercise, massage, and/or applications of ications; using exercise to improve breathing;
heat, cold, water, light, electricity, or ultrasound. monitoring ventilators; and performing diagnos-
Therapists assess the functional abilities of tic respiratory function tests (figure 3-13). Some
patients and use this information to plan treat- respiratory therapists are entrepreneurs.
ment programs. They also promote health and Respiratory therapy technicians (RTTs)
prevent injuries by developing proper exercise work under the supervision of respiratory thera-
programs and teaching patients correct use of pists and administer respiratory treatments, per-
muscles. Some physical therapists are entrepre- form basic diagnostic tests, clean and maintain
neurs.
Physical therapist assistants (PTAs),
working under the supervision of physical thera-
pists, help carry out prescribed plans of treat-
ment. They perform exercises and massages;
administer applications of heat, cold, and/or
water; assist patients to ambulate with canes,
crutches, or braces; provide ultrasound or elec-
trical stimulation treatments; inform therapists
of patients’ responses and progress; and perform
other duties, as directed by therapists.
Massage therapists usually work under the
supervision of physicians or physical therapists.
They use many variations of massage, bodywork
(manipulation or application of pressure to the
muscular or skeletal structure of the body), and FIGURE 3-13 Respiratory therapists (RTs)
therapeutic touch to muscles to provide pain provide treatments to patients with heart and lung
relief for chronic conditions (such as back pain) diseases.
66 CHAPTER 3
equipment, and note and inform therapists of Athletic trainers (ATCs) prevent and treat
patients’ responses and progress. athletic injuries and provide rehabilitative ser-
Surgical technologists/technicians (STs), vices to athletes. The athletic trainer frequently
also called operating room technicians (figure works with a physician who specializes in sports
3-14), working under the supervision of RNs or medicine. Athletic trainers teach proper nutri-
physicians, prepare patients for surgery; set up tion, assess the physical condition of athletes,
instruments, equipment, and sterile supplies in give advice regarding a physical conditioning
the operating room; and assist during surgery by program to increase strength and flexibility or
passing instruments and supplies to the surgeon. correct weaknesses, put tape or padding on play-
Although most surgical technologists/techni- ers to protect body parts, treat minor injuries,
cians work in hospital operating rooms, some are administer first aid for serious injuries, and help
employed in outpatient surgical centers, emer- carry out any rehabilitation treatment prescribed
gency departments, urgent care centers, physi- by sports medicine physicians or other thera-
cians’ offices, and other facilities. pists.
Speech–language pathologists, also Dialysis technicians, also called renal dial-
called speech therapists or speech scientists, iden- ysis technicians, hemodialysis technicians, or
tify, evaluate, and treat patients with speech and nephrology technicians, operate the kidney
language disorders. They help patients commu- hemodialysis machines used to treat patients
nicate as effectively as possible, and also teach with limited or no kidney function. Careful
patients to cope with the problems created by patient monitoring is critical during the dialysis
speech impairments. process. The dialysis technician must also pro-
Audiologists provide care to individuals vide emotional support for the patient and teach
who have hearing impairments. They test hear- proper nutrition (because many patients must
ing, diagnose problems, and prescribe treatment, follow restricted diets).
which may include hearing aids, auditory train- Perfusionists, also called extracorporeal
ing, or instruction in speech or lip reading. They circulation technologists, are members of open-
also test noise levels in workplaces and develop heart surgical teams and operate the heart–lung
hearing protection programs. machines used in coronary bypass surgery (sur-
Art, music, and dance therapists use the gery on the coronary arteries in the heart). This
arts to help patients deal with social, physical, or field is expanding to include new advances such
emotional problems. Therapists usually work as artificial hearts. Monitoring and operating
with individuals who are emotionally disturbed, these machines correctly is critical because the
mentally retarded, or physically disabled, but patient’s life depends on the machines. During
they may also work with adults and children who surgery, the perfusionist monitors blood gases
have no disabilities in an effort to promote physi- and vital signs; administers blood products, anes-
cal and mental wellness. thetic agents, and/or drugs as needed; and
induces hypothermia (low body temperature) to
decrease the body’s need for oxygen. After the
surgery, the perfusionist must restore normal
body circulation when the heart starts beating
and wean the patient from the extracorporeal
machine.
ADDITIONAL SOURCES
OF INFORMATION
♦ American Alliance for Health, Physical Educa-
tion, Recreation, and Dance
1900 Association Drive
FIGURE 3-14 Surgical technologists assist by Reston, VA 22091-1598
passing instruments and supplies to the surgeon. Internet address: www.aahperd.org
♦ American Art Therapy Association ♦ American Speech-Language-Hearing

1202 Allanson Road Association
Mundelheim, IL 60060-3808 10801 Rockville Pike
Internet address: www.arttherapy.org Rockville, MD 20852
Internet address: www.asha.org
♦ American Academy of Audiology
11730 Plaza America Drive, Suite 300 ♦ American Therapeutic Recreation Association
Reston, VA 20190 1414 Prince Street, Suite 204
Internet address: www.audiology.org Alexandria, VA 22314
Internet address: www.atra-tr.org
♦ American Association for Respiratory Care
9425 N. MacArthur Boulevard, Suite 100
♦ Associated Bodywork and Massage
Professionals
Irving, TX 75063-48706
1271 Sugarbush Drive
Internet address: www.aarc.org
Evergreen, CO 80439-9766
♦ American Association of Colleges of Internet address: www.abmp.com
Pharmacy ♦ Association of Surgical Technologists
1426 Prince Street 6 W. Dry Creek Circle
Alexandria, VA 22314 Littleton, CO 80120
Internet address: www.aacp.org Internet address: www.ast.org
♦ American Dance Therapy Association ♦ Massage and Bodywork Resource Center
10632 Little Patuxent Parkway Internet address: www.massageresource.com
Columbia, MD 21044 ♦ National Athletic Trainers Association
Internet address: www.adta.org 2952 Stemmons Freeway
♦ American Massage Therapy Association Dallas, TX 75247
820 Davis Street, Suite 100 Internet address: www.nata.org
Evanston, IL 60201-4444 ♦ National Therapeutic Recreation Society
Internet address: www.amtamassage.org 22377 Belmont Ridge Road
Ashburn, VA 20148
♦ American Music Therapy Association
Internet address: www.nrpa.org
8455 Colesville Road
Silver Spring, MD 20910 ♦ Pharmacy Technician Certification Board
Internet address: www.musictherapy.org 2215 Constitution Avenue NW
Washington, DC 20037-2985
♦ American Pharmacists Association Internet address: www.ptcb.org
2215 Constitution Avenue NW
Washington, DC 20037-2985 ♦ For information about specific tasks of a phar-
Internet address: www.aphanet.org macy technician/assistant, physical therapy
assistant/technician, or respiratory therapy
♦ American Physical Therapy Association assistant/technician, ask your instructor for
1111 N. Fairfax Street the Guideline for Clinical Rotations in the
Alexandria, VA 22314-1488 Diversified Health Occupations Teacher’s
Internet address: www.apta.org Resource Kit. Additional career information for
physical therapy is provided in the Career High-
♦ American Occupational Therapy Association light Section of Chapter 22 in this textbook.
4720 Montgomery Lane, P. O. Box 31220
Bethesda, MD 20824-1220
Internet address: www.aota.org
3:3 INFORMATION
♦ American Society of Extracorporeal Technolo-
gists Diagnostic Services Careers
2209 Dickens Road Diagnostic service workers are involved with cre-
P.O. Box 11086 ating a picture of the health status of a patient at
Richmond, VA 23230-1086 a single point in time. They perform tests or eval-
Internet address: www.amsect.org uations that aid in the detection, diagnosis, and
68 CHAPTER 3
treatment of disease, injury, or other physical Many careers fall under the designation of
conditions. diagnostic services. Some of the more common
Many workers are employed in hospital labo- ones are discussed in this chapter. There are vari-
ratories, but others work in private laboratories, ous levels of workers in most fields (table 3-14).
outpatient centers, doctors’ offices, clinics, pub- Electrocardiograph (ECG) technicians
lic health agencies, pharmaceutical (drug) firms, operate electrocardiograph machines, which
and research or government agencies. In some record electrical impulses that originate in the
occupations, individuals are entrepreneurs, own- heart. Physicians (especially cardiologists) use
ing and operating their own businesses. the electrocardiogram (ECG) to help diagnose
TABLE 3-14 Diagnostic Services Careers

Cardiovascular • Associate’s or bachelor’s degree Above average $27,500–$58,600

Technologist • Certification or registration can be obtained from growth
Cardiovascular Credentialing International
Registered Diagnostic • Registration can be obtained from the American
Vascular Technologist Registry of Diagnostic Medical Sonographers
(RDVT)
Electrocardiograph • 1–12 months on-the-job or 6–12-month-HSTE Below average $17,300–$32,800
(ECG Technician) program growth
Certified • Certification can be obtained from Cardiovascular
Cardiographic Credentialing International
Technician (CCT)
Electroencephalo- • Few have 1–2-years on-the-job Below average $22,300–$46,200
graphic (EEG) • Most have 1–2-year HSTE certification program or growth
Technologist associate’s degree
• Registration can be obtained from American Board of
Registration of Electroencephalographic and Evoked
Potential Technologists
Electroneurodiagnostic • 1–2-year program usually leading to associate’s Above average $35,800–$56,200
Technologist degree growth
• Registration can be obtained from the American
Board of Electroencephalographic and Evoked
Potential Technologists
• Polysomnographic technologists can obtain
registration from the Association of
Polysomnographic Technologists
Medical (Clinical) • Bachelor’s or master’s degree Average growth $35,800–$66,900
Laboratory • Licensure or registration required in some states
Technologist (MT) • Certification can be obtained from the American
Certified Medical Medical Technologists Association and the National
(Clinical) Laboratory Credentialing Agency for Laboratory Personnel
Technologist (CMT)
Registered Medical
(Clinical) Laboratory
Technologist (RMT)
(continued)
TABLE 3-14 Diagnostic Services Careers (Continued)

Medical (Clinical) • 2-year HSTE certification program or associate’s Average growth $26,300–$48,900
Laboratory Technician degree
(MLT) • Licensure or registration required in some states
Certified Laboratory • Certification can be obtained from the American
Technician (CLT) Medical Technologists Association and the National
Credentialing Agency for Laboratory Personnel
Medical (Clinical) • 1–2-year HSTE program or on-the-job training Below average $14,500–$26,300
Laboratory Assistant • Certification can be obtained from the Board of growth
Certified Laboratory Assistants
Phlebotomist • 1–2 years on the job or HSTE program or 100–300 Average growth $14,600–$28,300
hour certification program
• Certification can be obtained from the National
Credentialing Agency for Laboratory Personnel and
the American Society of Phlebotomy Technicians
Radiologic • Associate’s or bachelor’s degree Above average $28,900–$68,600
Technologist ARRT • Licensure required in most states growth
(Registered) • Registration can be obtained from American Registry
of Radiologic Technologies (ARRT)
heart disease and to note changes in the condi- An electroencephalographic (EEG) tech-
tion of a patient’s heart. ECG or cardiographic nologist operates an instrument called an elec-
technicians with more advanced training perform troencephalograph, which records the electrical
stress tests (which record the action of the heart activity of the brain. The record produced, called
during physical activity), Holter monitorings an electroencephalogram, is used by a variety of
(ECGs lasting 24–48 hours, figure 3-15), thallium physicians, especially neurologists (doctors spe-
scans (a nuclear scan after thallium is injected), cializing in nerve and brain diseases), to diagnose
and other specialized cardiac tests that frequently and evaluate diseases and disorders of the brain,
involve the use of computers. An associate’s or such as brain tumors, strokes, toxic/metabolic
bachelor’s degree leads to a position as a cardio- disorders, epilepsy, and sleep disorders. Advanced
vascular technologist. These individuals assist training leads to a position as an electroneuro-
with cardiac catheterization procedures and diagnostic technologist (END). In addition to
angioplasty (a procedure to remove blockages in performing EEGs, these individuals perform
blood vessels), monitor patients during open- nerve conduction tests, measure sensory and
heart surgery and the implantation of pacemak- physical responses to specific stimuli, perform
ers, and perform tests to check circulation in evoked potential (EP) tests that measure brain
blood vessels. Some specialize in using ultra- response when specific nerves are stimulated,
sound (high-frequency sound waves) to assess and operate other monitoring devices. Technolo-
heart function and diagnose heart conditions gists who specialize in administering sleep disor-
and are called echocardiographers or cardiac der evaluations are called polysomnographic
sonographers. Others use ultrasound to diagnose technologists.
disorders of blood vessels by checking blood Medical (clinical) laboratory technolo-
pressure, oxygen saturation, and circulation of gists (MTs) work under the supervision of doc-
blood throughout the body. They are called vas- tors called pathologists. They study tissues, fluids,
cular technologists or vascular sonographers. and cells of the human body to help determine
70 CHAPTER 3
FIGURE 3-16 Medical laboratory technologists

perform computerized blood analysis tests. (Photo
by Marcia Butterfield, courtesy of W. A. Foote
Memorial Hospital, Jackson, MI)
♦ Microbiology: study of bacteria and other

microorganisms
Medical (clinical) laboratory techni-
cians (MLTs), working under the supervision of
medical technologists or pathologists, perform
many of the routine tests that do not require the
advanced knowledge held by a medical technolo-
FIGURE 3-15 Cardiographic technicians assist gist. Like the technologist, the technician can
with Holter monitorings of the heart. specialize in a particular field or perform a vari-
ety of tests.
Medical (clinical) laboratory assistants,
working under the supervision of medical tech-
the presence and/or cause of disease. They per- nologists, technicians, or pathologists, perform
form complicated chemical, microscopic, and basic laboratory tests; prepare specimens for
automated analyzer/computer tests (figure 3-16). examination or testing; and perform other labo-
In small laboratories, technologists perform ratory duties such as cleaning and helping to
many types of tests. In larger laboratories, they maintain equipment.
may specialize. Examples of specialization Phlebotomists (figure 3-17), or venipunc-
include: ture technicians, collect blood and prepare it for
♦ Biochemistry: chemical analysis of body testing. In some states, they perform blood tests
fluids under the supervision of medical technologists
or pathologists.
♦ Blood bank technology: collection and prepa- Radiologic technologists (RTs), working
ration of blood and blood products for trans- under the supervision of doctors called radiolo-
fusions gists, use X-rays, radiation, nuclear medicine,
♦ Cytotechnology: study of human body cells ultrasound, and magnetic resonance to diagnose
and cellular abnormalities and treat disease. Most techniques are noninva-
♦ Hematology: study of blood cells sive, which means examining or treating the
internal organs of patients without entering the
♦ Histology: study of human body tissue body. In many cases, recent advances in this field
♦ Molecular biology: complex protein and have eliminated the need for surgery and, there-
nucleic acid testing on cell samples fore, offer less risk to patients. Radiologic tech-
FIGURE 3-17 Phlebotomists collect blood and

prepare it for testing.
nologists use different types of scanners to

produce images of body parts. Examples include
X-ray machines, fluoroscopes, ultrasonic scan-
ners, computerized tomography (CT) scanners
(formerly known as computerized axial tomogra-
phy [CAT] scanners), magnetic resonance imag-
ers (MRI), and positron emission tomography FIGURE 3-18 Radiologic technologists take X-
(PET) scanners. Many radiologic technologists rays used in the diagnosis of disease. (Photo by
also provide radiation treatment. Specific job Marcia Butterfield, courtesy of W. A. Foote Memorial
titles exist for technologists who specialize: Hospital, Jackson, MI)
♦ Radiographers: (figure 3-18) take X-rays of the
body for diagnostic purposes. vascular (blood vessels and blood flow), and
echocardiography (the heart) examinations.
♦ Radiation therapists: administer prescribed
doses of radiation to treat disease (usually ♦ Mammographer: uses a special mammography
cancer). machine to produce images of the breast. The
mammograms are used to assist in the early
♦ Nuclear medicine technologists: prepare radio- detection and treatment of breast cancer.
active substances for administration to
patients. Once administered, these profes- ♦ Computer tomography technologists: use a
sionals use films, images on a screen, or body special X-ray machine called a computerized
specimens such as blood or urine to deter- axial tomography (CT or CAT) scanner to
mine how the radioactive substances pass obtain cross-sectional images of body tissues,
through or localize in different parts of the bones, and organs. CT scans help locate
body. This information is used by physicians tumors and other abnormalities.
to detect abnormalities or diagnose disease. ♦ Magnetic resonance imaging (MRI) technolo-
♦ Ultrasound technologists or diagnostic medi- gists: use superconductive magnets and radio-
cal sonographers: use equipment that sends waves to produce detailed images of internal
high-frequency sound waves into the body. As anatomy. The information is processed by a
the sound waves bounce back from the part computer and displayed on a videoscreen.
being examined, an image of the part is viewed Examples of MRI use include identifying mul-
on a screen. This can be recorded on a print- tiple sclerosis and detecting hemorrhaging
out strip or be photographed. Ultrasound is (bleeding) in the brain.
frequently used to examine the fetus (devel- ♦ Positron emission tomography (PET) technolo-
oping infant) in a pregnant woman and can gists: inject a slightly radioactive substance
reveal the sex of the unborn child. Ultrasound into the patient and then operate the PET
is also used for neurosonography (the brain), scanner, which uses electrons to create a
72 CHAPTER 3
three-dimensional image of body parts and ♦ International Society for Clinical Laboratory
scan the body for disease processes. This Technology
allows physicians to see an organ or bone 917 Locust Street, Suite 1100
from all sides, similar to a model. St. Louis, MO 63101
♦ National Accrediting Agency for Clinical Lab-
oratory Sciences
ADDITIONAL SOURCES 8410 West Bryn Mawr Avenue, Suite 670
Chicago, IL 60631-3415
OF INFORMATION Internet address: www.naacls.org
♦ National Credentialing Agency for Laboratory
♦ Alliance of Cardiovascular Professionals Personnel
4356 Bonney Road, Suite 103 P.O. Box 15945-289
Virginia Beach, VA 23452-1200 Lenexa, KS 66285
Internet address: www.acp-online.org Internet address: www.nca-info.org
♦ American College of Radiology ♦ Society of Diagnostic Medical Sonography
1891 Preston White Drive 2745 Dallas Parkway, Suite 350
Reston, VA 22091 Dallas, TX 75093-8730
Internet address: www.acr.org Internet address: www.sdms.org
♦ American Medical Technologists ♦ For information about specific tasks of a med-
710 Higgins Road ical laboratory assistant/technician and a
Park Ridge, IL 60068 radiology assistant/technician, ask your
Internet address: www.amt1.com instructor for the Guideline for Clinical Rota-
♦ American Registry of Radiologic Technologists tions in the Diversified Health Occupations
1255 Northland Drive Teacher’s Resource Kit. Additional career infor-
St. Paul, MN 55120-1155 mation for medical laboratory assistants/
Internet address: www.arrt.org technicians is provided in the Career High-
♦ American Society for Clinical Laboratory light Section of Chapter 19 in this textbook.
Science
6701 Democracy Boulevard, Suite 300
Bethesda, MD 20814 3:4 INFORMATION
Internet address: www.ascls.org
♦ American Society of Electroneurodiagnostic Health Informatics Careers
Technologists Health informatics workers are involved with
426 W. 42nd Street documentation of patient records and health
Kansas City, MO 64111 information. There are many different types of
Internet address: www.aset.org health workers at all levels. Some examples of
♦ American Society of Radiologic Technologists careers in health informatics include health
15000 Central Avenue SE information administrators or technicians, health
Albuquerque, NM 87123-3917 educators, medical transcriptionists, admitting
Internet address: www.asrt.org office personnel, epidemiologists, medical illus-
trators, photographers, writers, and librarians
♦ Association of Schools of Allied Health (see table 3-15). Computer technology is used in
Professions almost all the careers.
1730 M Street, Suite 500 Places of employment include hospitals, clin-
Washington, DC 20036 ics, research centers, health departments, long-
Internet address: www.asahp.org. term care facilities, colleges, law firms, health
♦ Cardiovascular Credentialing International maintenance organizations (HMOs), and insur-
(CCI) ance companies.
1500 Sunday Drive, Suite 102 Health information (medical records)
Raleigh, NC 27607 administrators (RAs) develop and manage the
Internet address: www.cci-online.org systems for storing and obtaining information
TABLE 3-15 Health Informatics Careers

Health Information • Bachelor’s or master’s degree Above average $41,400–$88,700

(Medical Records) • Registration can be obtained from American Health growth
Administrator Information Management Association (AHIMA)
Registered (RRA)
Health Information • Associate’s degree Above average $22,700–$52,300
(Medical Records) • Registration can be obtained from the American Health growth
Technician Information Management Association (AHIMA) after
Registered (RHIT) passing a written examination
Medical • 1 or more years career or technical education program, Above average $18,700–$37,400
Transcriptionist on-the-job training, or associate’s degree growth
Certified Medical • Certification can be obtained from American Association
Transcriptionist for Medical Transcription
(CMT)
Admitting Officer • 1–2 year HSTE or business/office career/ technical Average growth $15,300–$36,800
or Clerk education
• Admitting manager may require bachelor’s degree
• Few have on-the-job training
Unit Secretary • 1 or more years career or technical education program Average growth $14,200–$34,300
Ward Clerk • Some have on-the-job training
Health Unit
Coordinator
Medical Records
Clerk
Epidemiologist • Master’s or doctoral degree in environmental health, Above average $55,000–$96,500
public health, or health management sciences growth
Medical • Associate’s, bachelor’s, or master’s degree Above average $31,800–$76,300
Interpreter/ • Certification for translators can be obtained from the growth
Translator American Translators Association
• Certification for sign language interpreters can be
obtained from the National Association of the Deaf and
the Registry of Interpreters for the Deaf
Medical Illustrator • Bachelor’s or master’s degree Average growth $43,700–$132,500
• Certification can be obtained from Association of
Medical Illustrators
Medical Librarian • Master’s degree in library science Average growth $41,600–$136,300
from records, prepare information for legal istrator to be able to operate and use a variety of
actions and insurance claims, compile statistics computer programs.
for organizations and government agencies, Health information (medical records)
manage medical records departments, ensure technicians, (figure 3-19), organize and code
the confidentiality of patient information, and patient records, gather statistical or research
supervise and train other personnel. Because data, record information on patient records,
computers are used in almost all aspects of the monitor electronic and paper-based information
job, it is essential for the medical records admin- to ensure confidentiality, and calculate bills using
74 CHAPTER 3
extended care facilities, clinics, and other health

facilities to record information on records; sched-
ule procedures or tests; answer telephones; order
supplies; and work with computers to record or
obtain information.
Epidemiologists identify and track dis-
eases as they occur in a group of people. They
determine risk factors that make a disease more
likely to occur, evaluate situations that may
cause occupational exposure to toxic sub-
stances, develop methods to prevent or control
the spread of new diseases, and evaluate statis-
tics and data to help governments, health agen-
cies, and communities deal with epidemics and
FIGURE 3-19 Health information (medical other health issues. Some may specialize in
records) technicians organize and code patients’ areas such as cancer, cardiovascular (heart and
records. blood vessels) diseases, occupational diseases,
infectious or communicable (spread rapidly
from person to person) diseases, and/or health
health care data. Computers have simplified care research.
many of the duties and are used to organize Medical interpreters/translators assist
records, compile and report statistical data, and cross-cultural communication processes by con-
perform similar tasks. Computer operation is an verting one language to another. Interpreters
important part of the education program for convert the spoken word while translators con-
health information technicians. Medical records vert written material. Medical interpreters/trans-
departments also employ clerks, who organize lators must be proficient at translating words,
records. Clerks typically complete a 1- or 2-year relaying concepts and ideas between languages,
career/technical program, or are trained on the practicing cultural sensitivity, editing written lan-
job. guage, and determining that the communication
Medical transcriptionists use a computer has been comprehended. Sign language inter-
and word processing software to enter data that preters facilitate communication for individuals
has been dictated on recorder by physicians or who are deaf or hard of hearing.
other health care professionals. Examples of data Medical illustrators use their artistic and
include physical examination reports, surgical creative talents to produce illustrations, charts,
reports, consultation findings, progress notes, graphs, and diagrams for health textbooks,
and radiology reports. journals, magazines, and exhibits. Another
Admitting officers/clerks work in the related field is a medical photographer, who takes
admissions department of a health care facility. photographs or records videotapes of surgical
They are responsible for obtaining all necessary procedures, health education information, docu-
information when a patient is admitted to the mentation of conditions before and after recon-
facility, assigning rooms, maintaining records, structive surgery, and legal information such as
and processing information when the patient is injuries received in an accident.
discharged. An admitting manager is a higher Medical librarians, also called health sci-
level of worker in this field, usually having an ences librarians, organize books, journals, and
associate’s or bachelor’s degree. The admitting other print materials to provide health informa-
manager is responsible for supervising staff, tion to other health care professionals. They use
developing and implementing policies and pro- computer technology to create information cen-
cedures for the department, monitoring perfor- ters for large health care facilities or to provide
mance standards, and coordinating the operation information to health care providers. Some librar-
of the department with other departments in the ians specialize in researching information for
health care facility. large pharmaceutical companies, insurance
Unit secretaries, ward clerks, or health agencies, lawyers, industry, and/or government
unit coordinators are employed in hospitals, agencies.
♦ American Translators Association

ADDITIONAL SOURCES 225 Reinekers Lane, Suite 590
OF INFORMATION Alexandria, VA 22314
Internet address: www.atanet.org
♦ American Association for Medical ♦ Association for Professionals in Infection
Transcription Control and Epidemiology
100 Sycamore Avenue 1275 K Street NW, Suite 1000
Modesto, CA 95354–0550 Washington, DC 20005
Internet address: www.aamt.org Internet address: www.apic.org
♦ American Health Information Management ♦ Association of Medical Illustrators
Association P.O. Box 1897
233 N. Michigan Avenue, Suite 2150 Lawrence, KS 66044
Chicago, IL 60601–5800 Internet address: www.ami.org
Internet address: www.ahima.org ♦ Medical Library Association
♦ American Medical Association Commission 65 East Wacker Plaza, Suite 1900
on Accreditation of Allied Health Education Chicago, IL 60602
Programs Internet address: www.mlanet.org
515 N. State Street ♦ Registry of Interpreters for the Deaf
Chicago, IL 60610 333 Commerce Street
Internet address: www.ama-assn.org Alexandria, VA 22314
Internet address: www.rid.org
TABLE 3-16 Support Services Careers

Health Care • Usually master’s or doctoral, but smaller facilities may Above average $48,500–$196,000
Administrator accept a bachelor’s degree growth
Health Services • Licensure required for long-term care facilities
Manager • Certification can be obtained from American College of
Health Care Executives
Biomedical • Bachelor’s or master’s degree Above average $48,500–$108,600
(Clinical) Engineer • Licensure required in some states growth
• Certification available from the International Certification
Commission for Clinical Engineering and Biomedical
Technology
Biomedical • Associate’s or bachelor’s degree Above average $26,300–$58,600
Equipment • Certification can be obtained from the International growth
Technician Certification Commission for Clinical Engineering and
(CBET-Certified) Biomedical Technology of the Association for the
Advancement of Medical Instrumentation
Central/Sterile • On-the-job training or 1–2-year HSTE program Average growth $12,200–$23,500
Supply Technician
Housekeeping • On-the-job training or 1-year career/technical program Above average $12,200–$24,700
Worker Sanitary growth
Manager
76 CHAPTER 3
3:5 INFORMATION
Support Services Careers
Support services workers are involved with creat-
ing a therapeutic environment to provide direct
or indirect patient care. Any hospital or health
care facility requires workers to operate the sup-
port departments such as administration, the
business office, the admissions office, central/
sterile supply, plant operations, equipment main-
tenance, and housekeeping. Each department
has workers at all levels and with varying levels of
education (see table 3-16).
Places of employment include hospitals, clin- FIGURE 3-20 Central/sterile supply workers
ics, long-term care facilities, HMOs, and public prepare all the equipment and supplies used by
health or governmental agencies. other departments in a health care facility.
Health care administrators, also called
health care executives or health services managers electrocardiographs, X-ray units, pacemakers,
plan, direct, coordinate, and supervise delivery of sterilizers, blood-gas analyzers, heart–lung
health care and manage the operation of health machines, respirators, and other similar devices.
care facilities. They are frequently called chief Lives depend on the accuracy and proper opera-
executive officers (CEOs). A health care adminis- tion of many of these machines, so constant
trator may be responsible for personnel, super- maintenance and testing for defects is critical.
vise department heads, determine budget and Some biomedical equipment technicians also
finance, establish policies and procedures, per- teach other staff members how to use biomedical
form public relations duties, and coordinate all equipment.
activities in the facility. Duties depend on the size Central/sterile supply workers (figure
of the facility. 3-20) are involved in ordering, maintaining, and
Biomedical (clinical) engineers combine supplying all the equipment and supplies used
knowledge of engineering with knowledge of by other departments in a health care facility.
biology and biomechanical principles to assist in They sterilize instruments or supplies, maintain
the operation of health care facilities. They design equipment, inventory materials, and fill requisi-
and build sensor systems that can be used for tions from other departments.
diagnostic tests, such as the computers used to Housekeeping workers/sanitary man-
analyze blood; develop computer systems that agers, also called environmental service workers,
can be used to monitor patients; design and pro- help maintain the cleanliness of the health care
duce monitors, imaging machines, surgical facility to provide a pleasant, sanitary environ-
instruments, lasers, and other similar medical ment. They observe all principles of infection
equipment; design clinical laboratories and other control to prevent the spread of disease.
units in a health care facility that uses advanced
technology; and monitor and maintain the oper-
ation of the technologic systems. They frequently ADDITIONAL SOURCES
work with other health team members such as
physicians or nurses to adapt instrumentation or OF INFORMATION
computer technology to meet the specific needs
of the patients and health care team. ♦ American College of Health Care
Biomedical equipment technicians Administrators
(BETs) work with the many different machines 300 N. Lee Street Suite 301
used to diagnose, treat, and monitor patients. Alexandria, VA 22314
They install, test, service, and repair equipment Internet address: www.achca.org
such as patient monitors, kidney hemodialysis ♦ American College of Healthcare Executives
units, diagnostic imaging scanners, incubators, One North Franklin Street, Suite 1700
Internet address: www.ache.org
3:6 INFORMATION
♦ American Health Care Association Biotechnology Research and
1201 L Street NW Development Careers
Washington, DC 20005 Biotechnology career workers are involved with
Internet address: www.ahca.org using living cells and their molecules to make
useful products. They work with cells and cell
♦ American Hospital Association products from humans, animals, plants, and
1 North Franklin Street
microorganisms. Through research and develop-
ment, they help produce new diagnostic tests,
Internet address: www.aha.org
forms of treatment, medications, vaccines to pre-
♦ Association for the Advancement of Medical vent disease, methods to detect and clean up
Instrumentation environmental contamination, and food prod-
3330 Washington Boulevard, Suite 400 ucts. The potential for the use of biotechnology is
Arlington, VA 22201-4598 unlimited.
Internet address: www.aami.org Places of employment include pharmaceuti-
cal companies, chemical companies, agricultural
♦ Biomedical Engineering Society facilities, research laboratories, colleges or uni-
8401 Corporate Drive, Suite 110 versities, government facilities, forensic labora-
Landover, MD 20785 tories, hospitals, and industry. There are many
Internet address: www.bmes.org career opportunities at all levels (table 3-17).
TABLE 3-17 Biotechnology Research and Development Careers

Biological or • Bachelor’s, master’s, or doctoral degree Average growth $52,600–$110,500

Medical • Licensure required in some states
Scientists
Biotechnological • Bachelor’s or master’s degree Average growth $48,600–$82,700
Engineers • Licensure required in some states
(Bioengineers)
Biological • Associate’s or bachelor’s degree Average growth $32,300–$62,500
Technicians • Certification can be obtained from the National
Credentialing Agency for Laboratory Personnel
Process • Associate’s degree Average growth $32,300–$59,400
Technicians • Some have bachelor’s degree
Forensic Science • Associate’s, bachelor’s, or master’s degree Above average $38,600–$67,300
Technicians • Most states do not have licensing or certification growth
requirements
• Must meet proficiency levels established by national
accreditation associations for criminal laboratories
• Certification can be obtained from the American Society
for Clinical Pathology
78 CHAPTER 3
Biological or medical scientists study

living organisms such as viruses, bacteria, proto-
zoa, and other infectious substances. They assist
in the development of vaccines, medicines, and
treatments for diseases; evaluate the relation-
ships between organisms and the environment;
and administer programs for testing food and
drugs. Some work on isolating and identifying
genes associated with specific diseases or inher-
ited traits, and perform research to correct genetic
defects. Some specialties include:
♦ Biochemists: study the chemical composition
of living things
♦ Microbiologists: investigate the growth and
characteristics of microscopic organisms
♦ Physiologists: study the life functions of plants
and animals
♦ Forensic scientists: study cells, fibers, and other
evidence to obtain information about a crime
♦ Biophysicists: study the response and interre-
lationship of living cells and organisms to the
principles of physics, such as electrical or
mechanical energy
Most biological or medical scientists use
research associates and assistants. These associ-
ates or assistants must have high-level math and
science skills, computer technology proficiency,
effective written and oral communication skills,
knowledge of aseptic techniques, and laboratory FIGURE 3-21 Biological technicians perform
skills. many of the laboratory experiments used for
Biotechnological engineers (bioengi- medical research. (Courtesy of CDC Public Health
neers) use engineering knowledge to develop Image Library/James Gathany)
solutions to complex medical problems. They
develop devices such as cardiac pacemakers, Biological technicians must be proficient in the
blood oxygenators, and defibrillators that aid in use of clinical laboratory equipment and com-
the diagnosis and treatment of disease; research puters. They must also be adept at compiling sta-
various metals and other biomaterials to deter- tistics and preparing research reports to
mine which can be used as implants in the human document experiments.
body; design and construct artificial organs, such Process technicians, working under the
as hip replacements, kidneys, heart valves, and supervision of biological scientists or research
artificial hearts; and research the biomechanics physicians, operate and monitor the machinery
of injury and wound healing. that is used to produce biotechnology products.
Biological technicians, working under the They may install new equipment, monitor the
supervision of biological scientists or biotechno- operation process of the equipment, assess qual-
logical engineers, assist in the study of living ity control of the finished product, and enforce
organisms. They perform many of the laboratory environmental and safety regulations. For exam-
experiments used in medical research on dis- ple, a process technician manufacturing drugs
eases such as cancer and acquired immune defi- for a pharmaceutical company may prepare and
ciency syndrome (AIDS). They also assist in the measure raw materials, load the raw materials
development, testing, and manufacturing of into the machinery, set the controls, operate the
pharmaceuticals or medications (figure 3-21). machinery, take test samples for quality control,

A robot that performs heart surgery?
Open-heart surgery is a major surgery. To correct heart defects or blocked blood vessels
in the heart, surgeons must saw the breastbone in two, pull back the ribs, and open the tho-
racic (chest) cavity with an incision that is usually about 1 foot long. In addition, open-heart
surgery requires a team of surgeons and other personnel.
Researchers have developed surgical robots that can perform this surgery with less
trauma to the patient. A physician makes just three small incisions, called ports, into the
chest. A tiny video camera is attached to one arm of a robot and inserted into one port. Sur-
gical instruments, such as a scalpel (knife) or forceps, are attached to other arms on the
robot and inserted into the other two ports as needed. The physician sits in front of a com-
puter screen showing the images from the camera inside the patient. The physician then
uses joystick-like controls to direct the actions of the robotic arms that hold the instruments.
The robot never gets tired as physicians do during long and delicate surgeries. Its hands
never “tremble” and its movements are exact. It simply follows the physician’s instructions
to perform the surgery. The patient recovers quickly and is usually sent home in one or two
days.
Currently, robotic heart surgery is still being researched. Different types of robots are
being evaluated. Researchers are trying to instill more artificial “intelligence” in the robots
being used. However, the future of robotic surgery is promising. Patients with heart defects
or disease may no longer have to dread open-heart surgery. A few small incisions in the
chest will allow a blocked blood vessel to be replaced and a heart condition cured.
and record required information. Process techni-

cians must use aseptic techniques and follow all
ADDITIONAL SOURCES
safety and environmental regulations during the OF INFORMATION
manufacturing process.
Forensic science technicians, also called ♦ American Academy of Forensic Sciences
criminalists, investigate crimes by collecting and P.O. Box 669
analyzing physical evidence. Examples of physi- Colorado Springs, CO 80901
cal evidence include weapons, clothing, shoes, Internet address: www.aafs.org
fibers, hair, body tissues, blood, body fluids, fin- ♦ American Institute of Biological Sciences
gerprints, chemicals, and even vapors in the air. 1444 I. Street NW, Suite 200
After the physical evidence is analyzed and pre- Washington, DC 20005
served, the forensic science technician works Internet address: www.aibs.org
with other investigative officers such as police
detectives to reconstruct a crime scene and find ♦ Biotechnology Industry Organization
the individual who committed the crime. Foren- 1225 Eye Street, NW, Suite 400
sic science technicians must be proficient in the Washington, DC 20005
use of laboratory equipment and computers. Internet address: www.bio.org
They must also be adept at preparing reports, ♦ Biotechnology Institute
compiling statistics, and testifying in trials or 1840 Wilson Boulevard, Suite 202
hearings. Arlington, VA 22201
Internet address: www.biotechinstitute.org
♦ Pharmaceutical Research and Manufacturers
of America
1100 Fifteenth Street, NW
Internet address: www.phrma.org
80 CHAPTER 3
STUDENT: Go to the workbook and complete Programs (CAAHEP) at www.caahep.org and

the assignment sheet for Chapter 3, Careers in the Accrediting Bureau of Health Education
Health Care. Schools (ABHES) at www.abhes.org to deter-
mine which health career programs are accred-
ited by each agency. Research schools in your
area that meet accreditation standards.
CHAPTER 3 SUMMARY 5. Schools: Search for technical schools, colleges,
and universities that offer educational pro-
More than 250 different careers in health care grams for a specific career. Evaluate entrance
provide individuals with opportunities to find requirements, financial aid, and programs of
occupations they enjoy. Each health care career study.
differs somewhat in the type of duties performed,
the education required, the standards that must
be met and maintained, and the salary earned. REVIEW QUESTIONS
This chapter has described some of the major
health care careers. For each career group, levels 1. Explain the differences and similarities
of workers, basic job duties, educational require- between secondary and post-secondary health
ments, anticipated need for workers through the care education?
year 2012, and average yearly salaries were pro- 2. For each of the post-secondary degrees listed,
vided. Use this chapter to evaluate the different state how many years of education are required
health careers, and request additional informa- to obtain the degree. For each degree, give
tion on specific careers from sources listed at three (3) examples of specific health care
the end of the respective career sections. In this careers that require the degree for entry-level
way, you can research various occupational op- workers.
portunities and determine which health care ca- a. Associate’s degree
reer is most appropriate for your interests and b. Bachelor’s degree
abilities. c. Master’s degree
d. Doctorate
INTERNET SEARCHES 3. Differentiate between certification, registra-

tion, and licensure.
Use the suggested search engines in Chapter 12:4 4. What are CEUs? Why are they required in many
of this textbook to search the Internet for addi- health care careers?
tional information on the following topics:
5. Name at least four (4) specific careers within
1. National Health Care Skill Standards (NHCSS): each cluster of the National Health Care Skill
review the history and development of health Standards.
care skill standards, and search for additional
information on the health science career 6. What is an entrepreneur? Identify five (5)
cluster. examples of health care careers that may be an
entrepreneur.
2. Health care careers: Search for information on
specific careers by entering the name of the 7. Choose one health care career in which you
career. have an interest. Use references or search the
Internet to list ten (10) specific tasks performed
3. Career organizations: Contact organizations at by personnel in the career.
web addresses listed in each career cluster to
determine the purpose of the organization, 8. Choose one health care career in which you
health careers it promotes, and advantages of have an interest. Use references or search the
membership. Internet to identify three (3) different schools
that offer accredited programs in the career.
4. Accreditation Agencies: Search the Commission
on Accreditation of Allied Health Education
CHAPTER 4 Personal and
Professional
Qualities of a
Health Care Worker
Chapter Objectives
Observe Standard ◆ Explain how diet, rest, exercise, good posture,
Precautions and avoiding tobacco, alcohol, and drugs
contribute to good health
◆ Demonstrate the standards of a professional
Instructor at This Point appearance as they apply to uniforms, shoes,
nails, hair, jewelry, and makeup
◆ Create a characteristic profile of a health care
Safety—Proceed with worker that includes at least eight personal/
Caution
professional traits or attitudes
◆ Identify four factors that interfere with
OBRA Requirement—Based communication
on Federal Law ◆ Explain the importance of listening, nonverbal
behavior, reporting, and recording in the
communication process
Math Skill
◆ Identify why teamwork is beneficial
◆ Identify six basic characteristics of leaders
Legal Responsibility ◆ Differentiate among democratic, laissez-faire,
and autocratic leaders
◆ Differentiate between positive and negative
Science Skill
stressors by identifying the emotional response
◆ List six ways to eliminate or decrease stress
Career Information ◆ Explain how time management, problem
solving, and goal setting reduce stress
Technology
82 CHAPTER 4
KEY TERMS
acceptance of criticism enthusiasm personal hygiene
autocratic leader feedback responsibility
communication goal self-motivation
competence honesty stress
(kom!-peh-tense) laissez-faire leader tact
cultural diversity leader team player
democratic leader leadership teamwork
dependability listening time management
discretion nonverbal communication willingness to learn
empathy (em!-path-ee") patience
INTRODUCTION als needed for optimum health. Foods from

each of the five major food groups (milk; meat;
Although health care workers are employed in vegetables; fruits; and bread, cereals, rice, and
many different career areas and in a variety of pasta) should be eaten daily. My Pyramid, dis-
facilities, certain personal/professional charac- cussed in Chapter 11:4, identifies the major
teristics, attitudes, and rules of appearance apply food groups.
to all health care professionals. This chapter dis- ♦ Rest: Adequate rest and sleep help provide
cusses these basic requirements. energy and the ability to deal with stress. The
amount of sleep required varies from individ-
ual to individual.
4:1 INFORMATION
♦ Exercise: Exercise maintains circulation,
Personal Appearance improves muscle tone, enhances mental atti-
tude, aids in weight control, and contributes
As a worker in any health career, it is important to
to more restful sleep. In addition, regular
present an appearance that inspires confidence
physical activity reduces the risk for coronary
and a positive self-image. Research has shown
heart disease, diabetes, colon cancer, hyper-
that within 20 seconds to 4 minutes people form
tension (high blood pressure), and osteoporo-
an impression about another person based
sis. Individuals should choose the form of
mainly on appearance. Although the rules of suit-
exercise best suited to their own needs, but
able appearance may vary, certain professional
should exercise daily.
standards apply to most health careers and
should be observed to create a positive impres- ♦ Good posture: Good posture helps prevent
sion. fatigue and puts less stress on muscles. Basic
principles include standing straight with
stomach muscles pulled in, shoulders relaxed,
GOOD HEALTH and weight balanced equally on each foot.
♦ Avoid use of tobacco, alcohol, and drugs: The
Health care involves promoting health and pre-
use of tobacco, alcohol, and drugs can seri-
venting disease. Therefore, a health care worker
ously affect good health. Tobacco affects the
should present a healthy appearance. Five main
function of the heart, circulatory system,
factors contribute to good health:
lungs, and digestive system. In addition, the
♦ Diet: Eating well-balanced meals and nutri- odor of smoke is offensive to many individu-
tious foods provides the body with the materials. For these reasons, most health care facili-
Personal and Professional Qualities of a Health Care Worker 83
ties are “smoke-free” environments. The use able. Extreme styles in any type of uniform should
of alcohol and drugs impairs mental function, be avoided. It is important that the health care
decreases ability to make decisions, and worker learn what type and color uniform is
adversely affects many body systems. The use required or permitted and follow the standards
of alcohol or drugs can also result in job loss. established by the place of employment.
Avoiding tobacco, alcohol, and drugs helps
prevent damage to the body systems and con-
tributes to good health. Clothing
If regular clothing is worn in place of a uniform,
the clothing must be clean, neat, and in good
PROFESSIONAL repair (figure 4-2). The style should allow for free-
APPEARANCE dom of body movement and should be appropri-
ate for the job. For example, while clean, neat
When you obtain a position in a health career, it jeans might be appropriate at times for a recre-
is important to learn the rules or standards of ational therapist, they are not proper attire for
dress and personal appearance that have been most other health professionals. Washable fab-
established by your place of employment. Abide rics are usually best because frequent laundering
by the rules and make every effort to maintain a is necessary.
neat, clean, and professional appearance.
Name Badge
Uniform Most health care facilities require personnel to
Many health occupations require uniforms. A wear name badges or photo identification tags at
uniform should always be neat, well fitting, clean, all times. The badge usually states the name, title,
and free from wrinkles (figure 4-1). Some agen- and department of the health care worker. In
cies require a white uniform, but others allow some health care settings, such as long-term care
pastel colors. In some facilities, the colors iden- facilities, workers are required by law to wear
tify groups of workers. If white uniforms are
required, white or neutral undergarments should
be worn. A large variety of uniform styles is avail-
FIGURE 4-1 Uniform styles may vary, but a FIGURE 4-2 If regular clothing is worn in place of
uniform should always be neat, well fitting, clean, a uniform, the clothing should reflect a professional
and free from wrinkles. appearance.
84 CHAPTER 4
identification badges. In addition, a health care Finally, the flash of bright colors may bother a
facility’s security regulations may require photo person who does not feel well. If nail polish is
identification tags to gain access into the build- worn, it should be clear or colorless, and the nails
ing or into certain areas inside the facility. must be kept scrupulously clean. Hand cream or
lotion should be used to keep the hands from
becoming chapped and dry from frequent hand-
Shoes washing.
Although white shoes are frequently required,
many occupations allow other types of shoes.
Any shoes should fit well and provide good sup- Hair
port to prevent fatigue. Low heels are usually best
because they help prevent fatigue and accidents. Hair should be kept clean and neat. It should
Avoid wearing sandals or open-toe shoes, unless be styled attractively and be easy to care for.
they are standard dress for a particular occupa- Fancy or extreme hairstyles, hair ornaments,
tion. Shoes should be cleaned daily. If shoelaces and/or unnatural hair colors should be avoided.
are part of the shoes, these must also be cleaned If the job requires close contact with patients,
or replaced frequently. Women should wear white long hair must be pinned back and kept off
or beige stockings or pantyhose with dress uni- the collar. This prevents the hair from touching
forms; colored or patterned stockings should be the patient/resident, falling on a tray or on
avoided. White socks should be worn with white equipment, or blocking necessary vision during
pants. procedures.
Personal Hygiene Jewelry

Good personal hygiene is essential. Because Jewelry is usually not permitted with a uniform
health care workers typically work in close con- because it can cause injury to the patient and
tact with others, body odor must be controlled. A transmit germs or pathogens. Exceptions some-
daily bath or shower, use of deodorant or antiper- times include a watch, wedding ring, and small,
spirant, good oral hygiene, and clean undergar- pierced earrings. Earrings with hoops or dangling
ments all help prevent body odor. Strong odors earrings should be avoided. Body jewelry, such as
caused by tobacco, perfumes, scented hairsprays, nose, eyebrow, or tongue-piercing jewelry, de-
and aftershave lotions can be offensive. In addi- tracts from a professional appearance and is pro-
tion, certain scents can cause allergic reactions in hibited in many health care facilities. When a
some individuals. The use of these products uniform is not required, jewelry should still be
should be avoided when working with patients limited. Excessive jewelry can interfere with
and co-workers. patient care and detracts from the professional
appearance of the health care worker.
Nails
Nails should be kept short, clean, and natural.
Many health care facilities prohibit the use of
Makeup and Tattoos
artificial nails. If fingernails are long and/or Excessive makeup should be avoided. The pur-
pointed, they can injure patients. They can also pose of makeup is to create a natural appearance
transmit germs, because dirt can collect under and add to the attractiveness of a person.
long nails and artificial nails. In addition, health Tattoos that are visible and/or offensive
care workers are now required to wear gloves for detract from a professional appearance and are
many procedures. Long nails can tear or punc- prohibited in many health care facilities. An
ture gloves. The use of colored nail polish is example is a tattoo on a hand or lower arm that
discouraged because the color can conceal any promotes gang membership. Some health care
dirt that may collect under the nails. Further, facilities require that any tattoo be covered by
because frequent handwashing causes polish to clothing at all times. Learn and follow the policies
chip, germs can collect on the surfaces of nails. established by your place of employment.
♦ Willingness to learn: You must be willing to

4:2 INFORMATION learn and to adapt to changes. The field of
Personal Characteristics health care changes constantly because of
research, new inventions, and technological
Many personal/professional characteristics and advances. Change often requires learning new
attitudes are required in the health occupations. techniques or procedures. At times, additional
As a health care worker, you should make every education may be required to remain compe-
effort to develop the following characteristics and tent in a particular field. Be prepared for life-
attitudes and to incorporate them into your per- long learning to maintain a competent level of
sonality. knowledge and skills.
♦ Empathy: Empathy means being able to ♦ Patience: You must be tolerant and under-
identify with and understand another person’s standing. You must learn to control your tem-
feelings, situation, and motives. As a health per and “count to ten” in difficult situations.
care worker, you may care for persons of all Learning to deal with frustration and over-
ages—from the newborn infant to the elderly come obstacles is important.
adult. To be successful, you must be sincerely
interested in working with people. You must
♦ Acceptance of criticism: Patients, families,
employers, co-workers, and others may criti-
care about others and be able to communi-
cize you. Some criticism will be constructive
cate and work with them. Understanding the
and allow you to improve your work. Remem-
needs of people and learning effective com-
ber that everyone has some areas where per-
munication techniques is one way to develop
formance can be improved. Instead of
empathy. This topic is covered in greater detail
becoming resentful, you must be willing to
in Chapter 4:3 of this text.
accept criticism and learn from it.
♦ Honesty : Truthfulness and integrity are impor-
tant in any career field. Others must be able to
♦ Enthusiasm: You must enjoy your work and
display a positive attitude. Enthusiasm is con-
trust you at all times. You must be willing to
tagious; it helps you do your best and encour-
admit mistakes so they can be corrected.
ages others to do the same. If you do not like
♦ Dependability : Employers and patients rely some aspects of your job, concentrating on
on you, so you must accept the responsibility the positive points can help diminish the
required in your position. You must be prompt importance of the negative points.
in reporting to work, and maintain a good
attendance record (figure 4-3). You must per-
♦ Self-motivation: Self-motivation, or self-
initiative, is the ability to begin or to follow
form assigned tasks on time and accurately.
through with a task. You should be able to
determine things that need to be done and do
them without constant direction. You set goals
for yourself and work to reach the goals.
♦ Tact: Being tactful means having the ability to
say or do the kindest or most fitting thing in a
difficult situation. It requires constant prac-
tice. Tactfulness implies a consideration for
the feelings of others. It is important to remem-
ber that all individuals have a right to their
respective feelings, and that these feelings
should not be judged as right or wrong.
♦ Competence: Being competent means that
you are qualified and capable of performing a
task. You follow instructions, use approved
procedures, and strive for accuracy in all you
FIGURE 4-3 A health care worker must report to do. You know your limits and ask for help or
work on time and maintain a good attendance guidance if you do not know how to perform a
record. procedure.
86 CHAPTER 4
♦ Responsibility : Responsibility implies being

willing to be held accountable for your actions. COMMUNICATION
Others can rely on you and know that you
will meet your obligations. Responsibility
PROCESS
means that you do what you are supposed The communication process involves three
to do. essential elements:
♦ Discretion: You must always use good judg- ♦ Sender: an individual who creates a message
ment in what you say and do. In any health to convey information or an idea to another
care career, you will have access to confiden- person
tial information. This information should not
be told to anyone without proper authoriza- ♦ Message: information, ideas, or thoughts
tion. A patient is entitled to confidential care; ♦ Receiver: an individual who receives the mes-
you must be discreet and ensure that the sage from the sender
patient’s rights are not violated.
Without a sender, message, and receiver, com-
♦ Team player : In any health care field, you munication cannot occur.
will become part of a team. It is essential that Feedback is a method that can be used to
you become a team player and learn to work determine whether communication was success-
well with others. Each member of a health ful. This occurs when the receiver responds to the
care team will have different responsibilities, message. Feedback allows the original sender to
but each member must do his or her part to evaluate how the message was interpreted and to
provide the patient with quality care. By work- make any necessary adjustments or clarification.
ing together, a team can accomplish goals Feedback can be verbal or nonverbal.
much faster than an individual. Even though the communication process
Each of the preceding characteristics and seems simple, many factors can interfere with
attitudes must be practiced and learned. Some the completion of the process. Important ele-
take more time to develop than do others. By ments of effective communication include:
being aware of these characteristics and striving ♦ The message must be clear. The message must
constantly to improve, you will provide good be in terms that both the sender and receiver
patient/resident care and be a valuable asset to understand. Health care workers learn and use
your employer and other members of the health terminology that is frequently not understood
care team. by those people who are not employed in health
care. Even though these terms are familiar to
the health care worker, they must be modified,
4:3 INFORMATION defined, or substituted with other words when
messages are conveyed to people not employed
Effective Communications in health care. For example, if a health care
Communicating effectively with others is an worker needs a urine specimen, some patients
important part of any health career. The can be told to urinate in a container. Others,
health care worker must be able to relate to such as very small children or individuals with
patients and their families, to co-workers, and to limited education, may have to be told to “pee”
other professionals. An understanding of com- or “do number one.” Even a term such as apical
munication skills will assist the health care worker pulse is not understood by many individuals.
who is trying to relate effectively. Instead of telling a patient, “I am going to take
Communication is the exchange of your apical pulse,” say, “I am going to listen to
information, thoughts, ideas, and feelings. It can your heart.” It requires experience and con-
occur through verbal means (spoken words), stant practice to learn to create a message that
written communications, and nonverbal behav- can be clearly understood.
ior such as facial expressions, body language, and ♦ The sender must deliver the message in a clear
touch. and concise manner. Correct pronunciation
and the use of good grammar are essential. The changing the form of the message, and getting
use of slang words or words with double mean- others to interpret or clarify the message are
ings should be avoided. Meaningless phrases some ways to help the receiver receive and
or terms such as “you know,” “all that stuff,” respond to the message.
“um,” and “OK,” distract from the message and
♦ The receiver must be able to understand the
also must be avoided. In verbal communica-
message. Using unfamiliar terminology can
tions, the tone and pitch of voice is important.
cause a breakdown in communication. Many
A moderate level, neither too soft nor too loud,
people do not want to admit that they do not
and good inflection, to avoid monotone, are
understand terms because they think others
essential. Think of the many different ways the
will think they are dumb. The health care
sentence “I really like this job” can be said and
worker should ask questions or repeat infor-
the different meanings that can be interpreted
mation in different terms if it appears that the
depending on the tone and pitch of the voice.
patient does not understand the information.
The proper rate, or speed, of delivering a mes-
The receiver’s attitude and prejudices can also
sage is also important. If a message is delivered
interfere with understanding. If a patient feels
too quickly, the receiver may not have enough
that health care workers do not know what
time to hear all parts of the message. In written
they are talking about, the patient will not
communications, the message should be
accept the information presented. Receivers
spelled correctly, contain correct grammar and
must have some confidence and belief in the
punctuation, and be concise but thorough.
sender before they will accept and understand
♦ The receiver must be able to hear and receive a message. It is important that health care
the message. Patients who are heavily medi- workers are willing to say, “I don’t know, but I
cated or are weak may nod their heads as if will try to find out that information for you,”
messages are heard, when, in reality, the when they are asked a question about which
patients are not receiving the information. they do not have correct knowledge. It is also
They may hear it, but it is not being inter- important for health care workers to be aware
preted and understood because of their physi- of their own prejudices and attitudes when
cal states. Patients with hearing or visual they are receiving messages from patients. If
impairments or patients with limited English- health care workers feel that certain patients
speaking abilities are other examples of indi- are lazy, ignorant, or uncooperative, they will
viduals who may not be able to easily receive not respond correctly to messages sent by
messages (figure 4-4). Repeating the message, these patients. Health care workers must be
aware of these feelings and work to overcome
them so they can accept patients as they are.
♦ Interruptions or distractions must be avoided.
Interruptions or distractions can interfere
with any communication. Trying to talk with
others while answering the phone or writing a
message can decrease the effectiveness of
spoken and/or written communication. Loud
noises or distractions in the form of bright
light or uncomfortable temperature can inter-
rupt communication. When two people are
talking outside in freezing temperatures, for
example, the conversation will be limited
because of the discomfort from the cold. A
small child jumping around or climbing up
FIGURE 4-4 In communicating with a person who and down off a mother’s lap will distract the
has a hearing impairment, face the individual and mother as she is getting instructions from a
speak slowly and distinctly. health care worker. A loud television or radio
88 CHAPTER 4
interferes with verbal messages, because Good listening allowed the patient to express
receivers may pay more attention to the radio fears and opened the way to more effective com-
or television than to the person speaking to munication. In this same case, the entire pattern
them. It is important to eliminate or at least of communication could have been blocked if
limit distractions if meaningful communica- the health care worker had instead responded,
tion is to take place. “That’s good.”
LISTENING NONVERBAL
Listening is another essential part of effective COMMUNICATION
communication. Listening means paying atten-
tion to and making an effort to hear what the Nonverbal communication involves the use
other person is saying. Good listening skills of facial expressions, body language, gestures,
require constant practice. Techniques that can be eye contact, and touch to convey messages or
used to learn good listening skills include: ideas (figure 4-5). If a person is smiling and sit-
ting in a very relaxed position while saying, “I am
♦ Show interest and concern for what the very angry about this entire situation,” two differ-
speaker is saying ent messages are being conveyed. A smile, a
♦ Be alert and maintain eye contact with the frown, a wink, a shrug of the shoulders, a bored
speaker expression, a tapping of fingers or feet, and other
similar body gestures or actions all convey mes-
♦ Avoid interrupting the speaker sages to the receiver. It is important for health
♦ Pay attention to what the speaker is saying care workers to be aware of both their own and
♦ Avoid thinking about how you are going to patients’ nonverbal behaviors because these are
respond an important part of any communication pro-
cess. A touch of the hand, a pat on the back, a
♦ Try to eliminate your own prejudices and see firm handshake, and a hug can convey more
the other person’s point of view
interest and caring than words could ever do.
♦ Eliminate distractions by moving to a quiet When verbal and nonverbal messages agree, the
area for the conversation receiver is more likely to understand the message
♦ Watch the speaker closely to observe actions being sent.
that may contradict what the person is saying
♦ Reflect statements back to the speaker to let
the speaker know that statements are being
heard
♦ Ask for clarification if you do not understand
part of a message
♦ Keep your temper under control and maintain
a positive attitude
Good listening skills will allow you to receive
the entire message a person is trying to convey to
you. For example, if a patient says, “I’m not wor-
ried about this surgery,” but is very restless and
seems nervous, the patient’s body movements
may indicate fear that is being denied by words.
The health care worker could reflect the patient’s
statement by saying, “You’re not at all worried
about this surgery?” The patient may respond by
saying, “Well, not really. It’s just that I worry about FIGURE 4-5 What aspects of listening and
my family if something should happen to me.” nonverbal behavior can you see in this picture?
sary to obtain the assistance of a sign language

BARRIERS TO interpreter to communicate with a deaf indi-
COMMUNICATION vidual.
♦ Blindness or impaired vision: People who are
A communication barrier is something that gets in blind or visually impaired may be able to hear
the way of clear communication. Three common what is being said, but they will not see body
barriers are physical disabilities, psychological language, gestures, or facial expressions. To
attitudes and prejudice, and cultural diversity. improve communication, use a soft tone of
voice, describe events that are occurring,
announce your presence as you enter a room,
Physical Disabilities explain sounds or noises, and use touch when
appropriate.
♦ Deafness or hearing loss: People who are deaf
or hearing impaired have difficulty receiving ♦ Aphasia or speech impairments: Aphasia is the
messages. To improve communication, it is loss or impairment of the power to use or
essential to use body language such as ges- comprehend words, usually as a result of
tures and signs, speak clearly in short sen- injury or damage to the brain. Individuals
tences, face the individual to improve the with aphasia or speech impairments can have
potential for lip reading, write messages if difficulty with not only the spoken word but
necessary, and make sure that any hearing also written communications. They may know
aids have good batteries and are inserted cor- what they want to say but have difficulty
rectly (figure 4-6). At times, it may be neces- remembering the correct words, may not be
able to pronounce certain words, or may have
slurred and distorted speech. Patience is
essential while working with these individu-
als. Allow them to try to speak, encourage
them to take their time, ask questions that
require only short responses, speak slowly and
clearly, pause between sentences to allow
them to comprehend what has been said,
repeat messages to be sure they are correct,
encourage them to use gestures or point to
objects, provide writing materials if they can
write messages, or use pictures with key mes-
sages to communicate (figure 4-7).
Psychological Barriers
Psychological barriers to communication are
often caused by prejudice, attitudes, and per-
sonality. Examples include closed-mindedness,
judging, preaching, moralizing, lecturing, overre-
acting, arguing, advising, and prejudging. Our
judgments of others are too often based on
appearance, lifestyle, and social or economic sta-
tus. Stereotypes such as “dumb blonde,” “lazy
bum,” or “fat slob” cause us to make snap judg-
ments about an individual and affect the com-
munication process.
Health care workers must learn to put prejudice
FIGURE 4-6 To be effective, hearing aids must be aside and show respect to all individuals. A home-
inserted correctly and have good batteries. less person deserves the same quality of health care
90 CHAPTER 4
and customs shared by a group of people and

passed from one generation to the next. It is often
defined as a set of rules, because culture allows
an individual to interpret the environment and
actions of others and behave appropriately. The
main barriers created by cultural diversity
include:
♦ Beliefs and practices regarding health and ill-

ness: Individuals from different cultures may
have their own beliefs about the cause of an
illness and the type of treatment required. It is
important to remember that they have the
right to determine their treatment plans and
even to refuse traditional treatments. At times,
these individuals may accept traditional health
care but add their own cultural remedies to
the treatment plan.
♦ Language differences: Language differences
can create major barriers. In the United States,
English is a primary language used in health
care. If a person has difficulty communicating
in English, and a health care worker is not flu-
FIGURE 4-7 Picture cards make it easier to
ent in another language, a barrier exists. When
communicate with a patient who has aphasia or a
speech impairment.
providing care to people who have limited
English-speaking abilities, speak slowly, use
as the president of the United States. It is important simple words, use gestures or pictures to clar-
to respect each person as an individual and to ify the meaning of words, and use nonverbal
remember that each person has the right to good communication in the form of a smile or gen-
care and considerate treatment. At times, this can tle touch. Avoid the tendency to speak louder
be extremely difficult, and patience and practice because this does not improve comprehen-
are essential. When individuals have negative atti- sion. Whenever possible, try to find an inter-
tudes or constantly complain or criticize your work, preter who speaks the language of the patient.
it can be difficult to show them respect. The health Frequently, another health care worker, a con-
care worker must learn to see beyond the surface sultant, or a family member may be able to
attitude to the human being underneath. assist in the communication process. In addi-
Frequently, fear is the cause of anger or a nega- tion, many health care facilities provide writ-
tive attitude. Allow patients to express their fears or ten instructions or explanations in several
anger, encourage them to talk about their feelings, different languages to facilitate the communi-
avoid arguing, remain calm, talk in a soft and non- cation process (figure 4-8).
threatening tone of voice, and provide quality care. ♦ Eye contact: In some cultures, direct eye-to-
If other health care workers seem to be able to eye contact while communicating is not
communicate more effectively with patients, watch acceptable. These cultures believe that look-
these workers to learn how they handle difficult or ing down shows proper respect for another
angry patients. This is often the most effective individual. A health care worker who feels that
means of learning good communication skills. eye contact is important must learn to accept
and respect this cultural difference and a per-
son’s inability to engage in eye contact while
Cultural Diversity communicating.
Cultural diversity, discussed in detail in Chap- ♦ Ways of dealing with terminal illness and/or
ter 9, is another possible communication barrier. severe disability: In the United States, a tradi-
Culture consists of the values, beliefs, attitudes, tional health care belief is that the patient
al’s right to cultural beliefs, a health care worker

can provide quality health care.
RECORDING AND
REPORTING
In health care, an important part of effective com-
munication is reporting or recording all observa-
tions while providing care. To do this, it is important
to not only listen to what the patient is saying, but
to make observations about the patient. All senses
FIGURE 4-8 Many health care facilities provide are used to make observations:
written instructions or explanations in several ♦ Sense of sight: notes the color of skin, swelling
different languages to facilitate communication with or edema, the presence of a rash or sore, the
individuals who have limited English-speaking color of urine or stool, the amount of food
abilities. eaten, and other similar factors
♦ Sense of smell: alerts a health care worker to
should be told the truth about his or her diag-
body odor or unusual odors of breath, wounds,
nosis and informed about the expected out-
urine, or stool
come. Some cultural groups believe that a
person should not be told of a fatal diagnosis ♦ Sense of touch: used to feel the pulse, dryness
or be burdened with making decisions about or temperature of the skin, perspiration, and
treatment. In these cultures, the family, the swelling
mother or father, or another designated indi- ♦ Sense of hearing: used while listening to respi-
vidual is expected to make decisions about rations, abnormal body sounds, coughs, and
care, treatment, and information given to the speech
patient. In such instances, it is important for
By using all senses, the health care worker
health care workers to recognize and respect
can learn a great deal about a patient’s condition
this and to involve these individuals in the
and be able to report observations accurately.
patient’s care. At times, it may be necessary for
Observations should be reported promptly to
a patient to use legal means, such as power of
an immediate supervisor. There are two types of
attorney for health care, to designate respon-
observations:
sibility for his or her care to another person.
♦ Touch: In some cultures, it is inappropriate to ♦ Subjective observations: These cannot be seen
touch someone on the head. Other cultures or felt, and are commonly called symptoms.
have clearly defined areas of the body that can They are usually statements or complaints
be touched or that should be avoided. Even a made by the patient. They should be reported
simple handshake can be regarded as showing in the exact words the patient used.
a lack of respect. In some cultures, only family ♦ Objective observations: These can be seen or
members provide personal care. For this rea- measured, and are commonly called signs. A
son, health care workers should always get bruise, cut, rash, or swelling can be seen.
permission from the patient before providing Blood pressure and temperature are measur-
care and should avoid any use of touch that able.
seems to be inappropriate for the individual.
For example, the health care worker should
Respect for and acceptance of cultural diver- not state, “I think Mr. B. has a fever.” The report
sity is essential for any health care worker. When should state, “Mr. B. is complaining of feeling hot.
beliefs, ideas, concepts, and ways of life are dif- His skin is red and flushed, and his temperature
ferent, communication barriers can result. By is 102°.”
making every attempt to learn about cultural dif- In some health care facilities, observations are
ferences and by showing respect for an individu- recorded on a patient’s health care record. Effec-
92 CHAPTER 4
tive communication requires these written obser- even prevent other family members from seeing
vations to be accurate, concise, and complete the information. If any health care provider allows
(figure 4-9). The writing should be neat and legi- information to be released from a medical record
ble, and spelling and grammar should be correct. without the patient’s permission, the patient can
Only objective observations should be noted. Sub- file a complaint that the privacy act has been vio-
jective observations that the health care worker lated. This act is discussed in more detail in Chap-
feels or thinks should be avoided. If a patient’s ter 5:1. It is important for every health care
statement is recorded, the statement should be provider to be aware of all parts of this act and to
written in the patient’s own words and enclosed in make every effort to protect the privacy and con-
quotation marks. All information should be signed fidentiality of the patient’s health care records.
with the name and title of the person recording
the information. Errors should be crossed out
neatly with a straight line, have “error” recorded by SUMMARY
them, and show the initials of the person making
the error. In this way, recorded communication Good communication skills allow health care
will be effective communication. workers to develop good interpersonal relation-
The Health Insurance Portability and ships. Patients feel accepted, they feel that others
Accountability Act (HIPAA) has established strict have an interest and concern in them, they feel
standards for maintaining confidentiality of free to express their ideas and fears, they develop
health care records. Under this act, patients have confidence in the health care workers, and they
total control on how information in their medical feel they are receiving quality health care. In addi-
records is used. Patients must be able to see and tion, the health care worker will relate more effec-
obtain copies of their records. They can set limits tively with co-workers and other individuals.
on who can obtain this information. They can
4:4 INFORMATION
Teamwork
In almost any health care career, you will be a
part of an interdisciplinary health care team. The
team concept was created to provide quality
holistic health care to every patient. Teamwork
consists of many professionals, with different
levels of education, ideas, backgrounds, and
interests, working together for the benefit of the
patient. For example, a surgical team might
include the following people:
♦ Admitting clerk: collects admission informa-
tion
♦ Insurance representative: obtains approval for
the surgery
♦ Nurses or patient care technicians: prepare the
patient for surgery
♦ Surgeons: perform the operation
♦ Anesthesiologist: administer anesthetics, med-
ications that decrease pain and/or conscious-
ness
♦ Operating room nurses: assist the surgeon
FIGURE 4-9 Information recorded on health care ♦ Surgical technicians: prepare and pass instru-
records must be accurate, concise, and complete. ments
♦ Housekeepers: clean and sanitize the area

♦ Sterile supply personnel: sterilize the instru-
ments
♦ Recovery room personnel: care for the patient
after surgery
After the surgery is complete, a dietitian,

social worker, physical therapist, occupational
therapist, home health personnel, and other
team members might be needed to assist the
patient as he/she recuperates. Each team mem-
ber has an important job to do. When the team
members work well together, the patient receives
quality care.
Teamwork improves communication and
continuity of care. When a team is assigned to a
particular patient, the patient knows his/her
caregivers and support staff. All the team mem-
bers can help to identify the needs of the patient,
offer opinions on the best type of care, partici- FIGURE 4-10 Most health care teams have
pate as decisions are made on options of care, frequent patient care conferences to establish team
and suggest additional professionals who might goals.
be able to assist with specific needs. This allows a
patient to become more educated about health
care options and to make informed decisions
regarding treatment and care. Leadership is discussed in more detail in Chapter
For a team to function properly, every person 4:5.
on the team must understand the role of each Good interpersonal relationships are also
team member. This knowledge provides a picture essential. Poor interpersonal relationships among
of the patient’s total care plan. It also helps clarify team members can harm the quality of care and
each person’s responsibility and establishes the prevent the team from meeting its goals. In the
goals that the team wants to achieve. Most teams same way, good interpersonal relationships can
have frequent patient care conferences, and in improve the quality of care. Members of a team
many instances, the patient is an active partici- will have different cultural and ethnic back-
pant (figure 4-10). Opinions are shared, options grounds, sexes, ages, socioeconomic statuses,
are discussed, decisions are made, and goals are lifestyle preferences, beliefs, and levels of educa-
established. During the conference, each team tion. Each team member must understand that
member must listen, be honest, express his/her these differences affect the way a person thinks
own opinion, and be willing to try different solu- and acts. Each person must be sensitive to the
tions. hopes, feelings, and needs of other team mem-
A leader is an important part of any team. The bers. The Golden Rule of “treat others as you
leader is responsible for organizing and coordi- would want to be treated” should be the main
nating the team’s activities, encouraging every- rule of teamwork. Some ways to develop good
one to share ideas and give opinions, motivating interpersonal relationships include:
all team members to work toward established ♦ Maintain a positive attitude and learn to laugh
goals, assisting with problems, monitoring the at yourself
progress of the team, and providing reports and ♦ Be friendly and cooperate with others
feedback to all team members on the effective-
ness of the team. A good team leader will also ♦ Assist others when you see that they need
allow others to assume the leadership role when help
circumstances indicate that another person can ♦ Listen carefully when another person is shar-
handle a particular situation more effectively. ing ideas or beliefs
94 CHAPTER 4
♦ Respect the opinions of others even though of others. A myth exists that leaders are born. In
you may not agree with them fact, leaders develop by their own efforts. Leaders
combine visions of excellence with the ability to
♦ Be open-minded and willing to compromise inspire others. They promote positive changes
♦ Avoid criticizing other team members that benefit their professions and the people they
♦ Learn good communication skills so you can serve. Anyone can learn to be a leader by making
share ideas, concepts, and knowledge an effort to understand the principles of leader-
ship. In a group, every member who makes a con-
♦ Support and encourage other team members
tribution to an idea can be considered a leader.
♦ Perform your duties to the best of your ability The leadership in the group passes from person
Conflict among individuals with different to person as each individual contributes to the
personalities is a problem that can occur when a achievement of the group’s goals.
group of people is working as a team. When con- Many different characteristics are assigned to
flict occurs, it is essential for each person to deal a leader. All the characteristics can be learned. In
with the conflict in a positive way. The people this way, leadership becomes a skill or function
involved in the conflict should meet, talk with that can be learned, rather than an inherited set
each other to identify the problem, listen to the of characteristics.
other person’s point of view, avoid accusations Some common characteristics may include:
and hostility, try to determine a way to resolve
♦ Respects the rights, dignity, opinions, and
the problem in a cooperative manner, and put
abilities of others
the agreed-upon solution into action. If a situa-
tion occurs where two people do not feel com- ♦ Understands the principles of democracy
fortable talking privately with each other, a ♦ Works with a group and guides the group
mediator may be able to assist with finding a toward a goal
solution to the problem. Some health care facili-
♦ Believes that changes and improvements can
ties have grievance committees to assist with
be accomplished
conflicts that may occur. If a team is to meet its
goals, conflict must be resolved. ♦ Participates in continuing education and pro-
Legal responsibilities are another important fessional development, and understands the
aspect of teamwork. Each member of a team concept of lifelong learning
must be aware of the legal limitations on duties ♦ Understands own strengths and weaknesses
that can be performed. All members must func- ♦ Displays self-confidence and willingness to
tion within legal boundaries. No team member take a stand
should ever attempt to solve a problem or per-
form a duty that is beyond the range of duties ♦ Communicates effectively and verbalizes ideas
legally permitted. clearly
Effective teams are the result of hard work, ♦ Shows self-initiative, a willingness to work,
patience, commitment, and practice. When each and completes tasks
individual participates fully in the team and ♦ Shows optimism, is open-minded, and can
makes every effort to contribute to the team, the compromise
team achieves success.
♦ Praises others and gives credit to others
♦ Dedicated to meeting high standards
4:5 INFORMATION
Leaders can often be classified into broad
Professional Leadership categories. Some of the categories include:
Leadership is an important concept in health religious, political, club or organizational, busi-
occupations. Leadership is the skill or ability to ness, community, expertise in a particular area,
encourage people to work together and do their and even informal or peer group. Leaders in
best to achieve common goals. A leader is fre- these categories often develop based on their
quently defined as an individual who leads or involvement with the particular category. An
guides others, or who is in charge or in command individual who joins a club or organization may
become a leader when the group elects the indi-

vidual to an office or position of leadership 4:6 INFORMATION
within the group.
Leaders are frequently classified as one of
Stress
three types based on how they perform their Stress can be defined as the body’s reaction to
leadership skills. The three main types of leader any stimulus that requires a person to adjust to a
are democratic, laissez-faire, and autocratic. changing environment. Change always initiates
stress. The stimuli to change, alter behavior, or
♦ Democratic leader: encourages the partici- adapt to a situation are called stressors. Stressors
pation of all individuals in decisions that have can be situations, events, or concepts. Stressors
to be made or problems that have to be solved. can also be external or internal forces. For exam-
This leader listens to the opinions of others, ple, a heart attack is an internal stressor, and a
and then bases decisions on what is best for new job is an external stressor.
the group as a whole. By guiding the individu- No matter what the cause, a stressor will
als to a solution, the leader allows the group to cause the body to go into an alarm or warning
take responsibility for the decision. mode. This mode is frequently called the “fight or
flight” reaction because of the physical changes
♦ Laissez-faire leader: more of an informal that occur in the body. When the warning is
type of leader. This leader believes in nonin-
received from a stressor, the sympathetic nervous
terference in the affairs of others. A laissez-
system prepares the body for action. Adrenaline,
faire leader will strive for only minimal rules
a hormone from the adrenal glands, is released
or regulations, and allow the individuals in a
into the bloodstream. It dilates blood vessels to
group to function in an independent manner
the heart and brain to increase blood circulation
with little or no direction. This leader almost
to these areas. At the same time, it constricts
has a “hands-off” policy, and usually avoids
blood vessels to the skin and other internal
making decisions until forced by circum-
organs, resulting in cool skin, decreased move-
stances to do so. The term laissez-faire comes
ment in the digestive tract, and decreased pro-
from a French idiom meaning “to let alone”
duction of urine. The pupils in the eyes dilate to
and can be translated to mean “allow to act”;
improve vision. Saliva production decreases and
therefore, it is an appropriate term to use for
the mouth becomes dry. The heart beats more
this type of leader.
rapidly, blood pressure rises, and the respiratory
♦ Autocratic leader: often called a “dictator.” rate increases. These actions by the sympathetic
This individual maintains total rule, makes all nervous system help provide the body with a
of the decisions, and has difficulty delegating burst of energy and the stamina needed to
or sharing duties. This type of leader seldom respond to the stressor.
asks for the opinions of others, emphasizes After the individual responds to the stressor
discipline, and expects others to follow direc- and adapts or changes as needed, the parasym-
tions at all times. Individuals usually follow pathetic system slowly causes opposite reactions
this type of leader because of a fear of punish- in the body. This results in fatigue or exhaustion
ment or because of an extreme loyalty. while the body returns to normal and recuper-
ates. If the body is subjected to continual stress
All types of leadership have advantages and with constant “up and down” nervous system
disadvantages. In some rare situations, an auto- reactions, the normal functions of the body will
cratic leader may be beneficial. However, the be disrupted. This can result in a serious illness
democratic leader is the model frequently pre- or disease. Many diseases have stress-related ori-
sented as most effective for group interactions. gins. Examples include migraine headaches, anx-
By allowing a group to share in deciding what, iety reactions, depression, allergies, asthma,
when, and how something is to be done, mem- digestive disorders, hypertension (high blood
bers of the group will usually do what has to be pressure), insomnia (inability to sleep), and heart
done because they want to do it. Respecting the disease.
rights and opinions of others becomes the most Everyone experiences a certain degree of
important guide for the leader. stress on a daily basis. The amount of stress felt
96 CHAPTER 4
usually depends on the individual’s reaction to of stress you are comfortable with, the type of
and perception of the situation causing stress. stress that motivates you effectively, and the type
For example, a blood test can be a routine event of stress that is unpleasant. If a chronic daily
for some individuals, such as a diabetic who per- stressor is heavy traffic on the road to work, it
forms three or four blood tests on a daily basis. may be time to evaluate the possibility of finding
Another individual who is terrified of needles a new way to work, leaving earlier or later to avoid
might feel extreme stress when a blood test is traffic, or finding a way to relax while stuck in
necessary. Many different things can cause stress. traffic. Stressors are problems that must be solved
Examples include relationships with family, or eliminated. One way to do this is to use the
friends, and co-workers; job or school demands; problem-solving method. It consists of the follow-
foods such as caffeine, excessive sweets, and salt; ing steps:
illness; lifestyle; financial problems; family events
such as birth, death, marriage, or divorce; over-
♦ Gather information or data. Assess the situa-
tion to obtain all facts and opinions.
work; boredom and negative feelings; time limi-
tations (too much to do and not enough time to ♦ Identify the problem. Try to identify the real
do it); and failure to achieve goals. stressor and why it is causing a reaction.
Not all stress is harmful. In fact, a small ♦ List possible solutions. Look at all ways to
amount of stress is essential to an individual’s eliminate or adapt to the stressor; include
well-being because it makes a person more alert both good and bad ideas; then, evaluate each
and raises the energy level. The individual is able of the ideas and try to determine how effective
to make quick judgments and decisions, becomes it will be.
more organized, and is motivated to accomplish
♦ Make a plan. After evaluating the solutions,
tasks and achieve goals. The way in which an
choose one that you think will have the best
individual responds to stressors determines
outcome.
whether the situation is helpful or harmful. If
stress causes positive feelings such as excitement, ♦ Act on your solution. Use the solution to your
anticipation, self-confidence, and a sense of problem to see if it has the expected outcome.
achievement, it is helpful. If stress causes nega- Does it allow you to eliminate or adapt to the
tive feelings such as boredom, frustration, irrita- stressor?
bility, anger, depression, distrust of others, ♦ Evaluate the results. Determine whether the
self-criticism, emotional and physical exhaus- action was effective. Did it work or is another
tion, and emotional outbursts, it is harmful. Neg- solution better?
ative stress can also lead to substance abuse. An
♦ Change the solution. If necessary, use a differ-
individual may smoke more, drink large amounts
ent solution that might be more effective.
of alcohol, take drugs, or eat excessively to find
comfort and escape from the negative feelings. Learning to manage a stress reaction is
Prolonged periods of harmful stress can lead to another important way of dealing with stressors.
burnout or a mental breakdown. For this reason, When you become aware that a stressor is caus-
an individual must become aware of the stressors ing a physical reaction in your body, use the fol-
in his/her life and learn methods to control lowing four-step plan to gain control:
them.
The first step in learning how to control stress
♦ Stop: immediately stop what you are doing to
break out of the stress response
is to identify stressors. Recognizing the symp-
toms of “fight or flight” can lead to an awareness ♦ Breathe: take a slow deep breath to relieve the
of the factors that cause these symptoms. By physical tension you are feeling
keeping a list or diary of stressors, an individual ♦ Reflect: think about the problem at hand and
can begin to evaluate ways to deal with the stress- the cause of the stress
ors and/or ways to eliminate them. When stress-
♦ Choose: determine how you want to deal with
ful events occur, note what the event was, why
the stress
you feel stress, how much stress you experience,
and how you deal with the stress. Do you tackle The brief pause that the four-step method
the cause of the stress or the symptom? This type requires allows an individual to become more
of information allows you to understand the level aware of the stressor, the physical reaction to the
stressor, and the actual cause of the stress. This ♦ Think positively: reflect on your accomplish-
awareness can then be used to determine whether ments and be proud of yourself
a problem exists. If a problem does exist, a solu-
tion to the problem must be found.
♦ Develop outside interests: provide time for
yourself; do not allow a job to dominate your
Many other stress-reducing techniques can
life
be used to manage stress. Some of the more com-
mon techniques include: ♦ Seek assistance or delegate tasks: ask others for
help or delegate some tasks to others; remem-
♦ Live a healthy life: eat balanced meals, get suf- ber that no one can do everything all of the
ficient amounts of rest and sleep, and exercise time
on a regular basis
♦ Avoid too many commitments: learn to say
♦ Take a break from stressors: sit in a comfort- “no”
able chair with your feet up
It is important to remember that stress is a
♦ Relax: take a warm bath
constant presence in every individual’s life and
♦ Escape: listen to quiet, soothing music cannot be avoided. However, by being aware of
♦ Relieve tension: shut your eyes, take slow deep the causes of stress, by learning how to respond
breaths, and concentrate on relaxing each when a stress reaction occurs, by solving prob-
muscle that is tense lems effectively to eliminate stress, and by prac-
ticing techniques to reduce the effect of stress, an
♦ Rely on others: talk with a friend and reach out
individual can deal with the daily stressors in his/
to your support system (figure 4-11)
her life and even benefit from them. It is also
♦ Meditate: think about your values or beliefs in important for every health care worker to remem-
a higher power ber that patients also experience stress, especially
♦ Use imagery: close your eyes and use all your when they are dealing with an illness and/or dis-
senses to place yourself in a scene where you ability. The same techniques can be used by the
are at peace and relaxed health care worker to help patients learn to deal
♦ Enjoy yourself: find an enjoyable leisure activ- with stress.
ity or hobby to provide “time outs”
♦ Renew yourself: learn new skills, take part in a 4:7 INFORMATION
professional organization, participate in com-
munity activities, and make every effort to Time Management
continue growing as an individual
One way to help prevent stress is to use time
management. Time management is a system
of practical skills that allows an individual to use
time in the most effective and productive way
possible. Time management helps prevent or
reduce stress by putting the individual in charge,
keeping things in perspective when events are
overwhelming, increasing productivity, using
time more effectively, improving enjoyment of
activities, and providing time for relaxing and
enjoying life.
The first step of time management is to keep
an activity record for a period of several days. This
allows an individual to determine how he/she
actually uses the time available. By listing activi-
ties as they are performed, noting the amount of
time each activity takes, and evaluating how
effective the activity was, an individual can see
FIGURE 4-11 Relaxing and talking with a friend is patterns emerging. Certain periods of the day will
one way to reduce stress. show higher energy levels and an improved qual-
98 CHAPTER 4
ity of work. Other periods may indicate that ♦ Narrow your career choices to the health care
accomplishments are limited because of fatigue. fields that you like best.
Wasted time will also become apparent. Time
spent looking for objects, talking on the tele-
♦ Investigate which high-school courses you
should take to meet college entry require-
phone, playing games on a computer, and doing
ments for these health careers.
things that are not worthwhile is time that can be
put to more constructive use. After this informa- ♦ Take the required courses in English, math,
tion has been obtained, an individual can begin science, computer technology, and other spe-
to organize time. Important projects can be cific academic areas.
scheduled during the periods of the day when ♦ Explore the career and technology programs
energy levels are high. Rest or relaxation periods offered by your high school.
can be scheduled when energy levels are low.
♦ Enroll in a health science technology educa-
tion (HSTE) program if one is available.
SETTING GOALS ♦ Join a student organization for HSTE students
to network with other people who have simi-
Goal setting is another important factor of time lar interests.
management. A goal can be defined as a desired
♦ Obtain a job or work as a volunteer in health
result or purpose toward which one is working.
care areas to determine which career you like
Goals can be compared with maps that help you
best.
find your direction and reach your destination.
An old saying states, “If you don’t know where you ♦ Research and visit different colleges or techni-
are going, you will never get there.” Goals allow cal schools to learn about course offerings,
you to know where you are going and provide financial aid, entry requirements, and other
direction to your life. similar information.
Everyone should have both short- and long- When this person is in the junior or senior
term goals. Long-term goals are achievements year of high school, short-term goals might
that may take a period of years or even a lifetime include:
to accomplish. Short-term goals usually take
days, weeks, or months to accomplish. They are ♦ Complete all required high-school courses
the smaller steps that are taken to reach the long- and maintain a high grade point average.
term goal. For example, a long-term goal might ♦ Confer with guidance or career counselors to
be to graduate from college with a health care obtain information on scholarships, financial
degree. help, career planning, college life, and other
If the person with this goal is starting high similar topics.
school, short-term goals might include:
♦ Apply to several colleges or technical schools
♦ Research and learn about the wide variety of that have accredited programs in the chosen
health careers. health field.
♦ Job-shadow health careers that seem most ♦ Arrange for financial assistance and/or obtain
interesting. a part-time job to save money for college.
♦ Talk with people in different health care ♦ Check living arrangements at the college areas
careers to find out about the careers. if living away from home will be necessary.
♦ Complete job interest surveys to determine ♦ After being accepted by colleges or technical
how your own skills and interests match schools, evaluate each individually to choose
requirements for different health careers. the school you will attend.
♦ Discuss career opportunities with a guidance ♦ Notify the school you have selected before the
or career counselor. established deadline for enrollment.
♦ Attend job fairs or career planning days to These short-term goals are basic suggestions.
obtain information on specific health careers. Each individual has to establish his/her own
♦ Use a computer to research health careers on goals. It is important to remember that short-
the Internet. term goals will change constantly as one set is
completed and a new set is established. Comple- from the most important to the least impor-
tion of a goal, however, will lead to a sense of sat- tant; decide if any tasks can be delegated to
isfaction and accomplishment, and provide another person to complete and delegate
motivation to attempt other goals. To set goals whenever possible; eliminate unnecessary
effectively, you must observe certain points. tasks
These points include: ♦ Identify habits and preferences: know when
♦ State goals in a positive manner. Use words you have the most energy to complete work
such as “accomplish” rather than “avoid.” and when it is best to schedule rest, exercise,
♦ Define goals clearly and precisely. If possible, or social activities
set a time limit to accomplish the goal. ♦ Schedule tasks: use the daily planner and cal-
♦ Prioritize multiple goals. Determine which endar to write down all events; be sure to
goals are the most important and complete include time for rest, exercise, meals, hobbies,
them first. and social activities; if a conflict arises with
two things scheduled at the same time, priori-
♦ Write goals down. This makes the goal seem tize and reschedule
real and attainable.
♦ Make a daily “to do” list: list all tasks on a daily
♦ Make sure each goal is at the right level. Goals basis; as you complete each one, cross it off
should present a challenge, but not be too dif-
the list; enjoy the sense of satisfaction that
ficult or impossible to complete.
occurs as you complete each job; if some
After goals have been established, concen- things on the list are not completed at the end
trate on ways to accomplish them. Review neces- of the day, determine if they should be added
sary skills, information that must be obtained, to the next day’s list or if they can be elimi-
resources you can use, problems that may occur, nated
and which goal should be completed first. Basi-
♦ Plan your work: work at a comfortable pace;
cally, this is just organizing the steps that will lead
try to do the hardest tasks first; do one thing at
to achieving the goal. After the goal has been
a time whenever possible so you can complete
achieved, enjoy your sense of accomplishment
it and cross it off the list; make sure you have
and satisfaction for a job well done. If you fail in
everything you need to complete the task
obtaining the goal, evaluate the situation and
before you begin; ask for assistance when
determine why you failed. Was the goal unrealis-
needed; work smarter, not harder
tic? Did you lack the skills or knowledge to obtain
the goal? Is there another way to achieve the goal? ♦ Avoid distractions: make every effort to avoid
Remember that failure can be a positive learning interruptions; use a telephone answering sys-
experience. tem and screen calls; avoid procrastination;
learn to say “no” when asked to interrupt your
work for something that is not essential
TIME MANAGEMENT ♦ Take credit for a job well done: when a job is
PLAN complete, recognize your achievement; cross
the completed work off the list; if the task was
Time management is used to ensure success in a particularly hard one, reward yourself with a
meeting established goals. A daily planner and short break or other positive thing before
calendar are essential tools. These tools allow an going on to the next job on the list
individual to write everything down, organize all
These steps of time management provide for an
information, become aware of conflicts (two
organized and efficient use of time. However,
things to do at the same time), and provide an
even with careful planning, things do not always
organized schedule to follow. An effective time
get done according to plan. Unexpected emer-
management plan involves the following seven
gencies, a new assignment, a complication, and/
steps:
or overscheduling are common events in the life
♦ Analyze and prioritize: review and list estab- of a health care worker. When a time manage-
lished goals; determine what tasks must be ment plan does not work, try to determine the
completed to achieve goals; list tasks in order, reasons for failure. Reevaluate goals and revise
100 CHAPTER 4
the plan. Patience, practice, and an honest effort ity time for rest and relaxation, a sense of being in
will eventually produce a plan that provides self- control, a healthier lifestyle, and increased pro-
satisfaction for achieving goals, less stress, qual- ductivity.

Melting fat to lose weight?
According to statistics from the National Health and Nutrition Examination Survey,
nearly two-thirds of adults in the United States are overweight. In addition, more than one-
third of these individuals are extremely overweight, or obese (20 percent or more above the
recommended weight). Research has shown that obesity is a risk factor for the development
of diabetes, heart disease, hypertension (high blood pressure), stroke, and even some forms
of cancer.
Scientists are now researching a unique approach to treat obesity. They are trying to
starve adipose (fatty) tissue by destroying the blood vessels that feed it. Fat cells grow
and multiply quickly by creating tiny blood vessels called capillaries, which provide nour-
ishment. Estimates are that 1 pound of fat contains a mile of blood vessels. A protein, pro-
hibitin, located on the surface of fat-feeding blood vessels, seems to regulate cell growth.
Scientists have developed a compound that attaches to prohibitin and selectively destroys
the blood vessels. When the compound was injected into obese mice, the mice lost about 30
percent of their body weight within 4 weeks. Further research is now being conducted to
determine the effect of this compound on baboons.
One obstacle to using this compound in humans is that prohibitin is found in cells
throughout the body. Care will have to be taken to make sure that other tissues and blood
vessels are not destroyed. If researchers are able to create a substance that destroys only the
blood vessels to adipose tissue, they will be able to “melt” fat by literally starving it to death.
If this occurs, obesity and many of the diseases caused by obesity will be eliminated.
STUDENT: Go to the workbook and complete avoiding the use of tobacco, alcohol, and drugs,
the assignment sheet for Chapter 4, Personal and a health care worker can strive to maintain good
Professional Qualities of a Health Care Worker. health. Wearing the appropriate uniform or ap-
propriate clothing and shoes is essential to pro-
jecting the proper image. Proper hair and nail
CHAPTER 4 SUMMARY care, good personal hygiene, and limited make-
up also help create a professional appearance.
Certain personal characteristics, attitudes, and Personal characteristics such as honesty, de-
rules of appearance apply to health care workers pendability, patience, enthusiasm, responsibil-
in all health careers. Every health care worker ity, discretion, and competence are essential. In
must constantly strive to develop the necessary addition, health care workers must be willing to
characteristics and to present a professional ap- learn and to accept criticism. These characteris-
pearance. tics must be practiced and learned.
A professional appearance helps inspire con- Effective communication is an important
fidence and a positive self-image. Good health aspect of helping individuals through stages of
is an important part of appearance. By eating growth and development and in meeting needs.
correctly, obtaining adequate rest, exercising A health care worker must have an understand-
daily, observing the rules of good posture, and ing of the communication process, factors that
interfere with communication, the importance preparing written “to do” lists and crossing off
of listening, and verbal and nonverbal commu- work that has been completed, planning work
nication. Another important aspect of commu- carefully, avoiding distractions, and taking cred-
nication is the proper reporting or recording of it for a job well done. An effective time manage-
all observations noted while providing care. ment plan will reduce stress, help an individual
Communication barriers such as physical attain goals, increase self-confidence, lead to a
disabilities, psychological attitudes, and cultural healthier lifestyle, and provide quality time for
diversity can interfere with the communication rest and relaxation.
process. Special consideration must be given to Health care workers must learn and follow
these barriers to improve communication. Some the standards and requirements established by
cultural groups have beliefs and practices that the health care facility in which they are em-
may relate to health and illness. Because indi- ployed.
viduals will respond to health care according to
their cultural beliefs, a health care worker must
be aware of and show respect for different cul- INTERNET SEARCHES
tural values in order to provide optimal patient
care. Use the suggested search engine in Chapter 12:4
Teamwork is important in any health care of this textbook to search the Internet for addi-
career. Interdisciplinary health care teams pro- tional information on the following topics:
vide quality holistic health care to every patient.
1. Uniform companies: search “uniform suppli-
Teamwork improves communication and conti-
ers” to locate companies that sell professional
nuity of care. A picture of the patient’s total care
uniforms and compare styles, prices, and so
plan is clear when the role of each team member
forth.
is known. For a team to function effectively, it
needs a qualified leader, good interpersonal re- 2. Professional characteristics: choose a specific
lationships, ways to avoid or deal with conflict, health care career and search for career
positive attitudes, and respect for legal respon- descriptions; list the required personal quali-
sibilities. Effective teams are the result of hard ties or characteristics necessary for the career
work, patience, commitment, and practice. you have chosen.
Leadership is a skill that can be learned 3. Communication: search for information on
by mastering the characteristics of a leader. A listening skills, nonverbal communication, and
leader may or may not be a supervisor; any mem- the communication process.
ber of a group that contributes to the group’s
goals can be considered a leader. Of the three 4. Leadership: search for information on types
types of leaders—democratic, laissez-faire, and and characteristics of leaders; evaluate which
autocratic—the democratic leader is the most types would be most effective in guiding a
effective for group interaction. health care team.
Stress is a component in every individual’s 5. Stress: search for information on stress and
life. Stress can be good or bad, depending on the stress-reducing techniques.
person’s perception of and reaction to the stress.
By being aware of the causes of stress, learning 6. Time management: search for information on
how to respond when a stress reaction occurs, time management.
solving problems to eliminate stress, and prac-
ticing techniques to reduce the effect of stress,
an individual can deal with stress and even ben- REVIEW QUESTIONS
efit from it.
Time management is a system of practi- 1. What five (5) main factors contribute to good
cal skills that allow an individual to use time in health?
the most effective and productive way possible.
2. Identify eight (8) specific principles that must
It involves analyzing how one actually uses the
be followed for a professional appearance.
time available, establishing short- and long-
term goals, prioritizing tasks that must be ac- 3. Create a personal description of yourself
complished, identifying habits and preferences, showing why you display at least six (6) of the
102 CHAPTER 4
personal characteristics desired in a health 8. List six (6) characteristics of an effective leader.
care worker.
9. Identify the three (3) types of leaders and
4. Why is it important to observe both verbal and describe their style of leadership.
nonverbal communication? Create a specific
10. Identify at least one major stress in your life.
example of a situation showing how both
List the steps of the problem-solving method
verbal and nonverbal communication convey a
and then apply the stressor you have chosen to
message.
each of the steps. Identify at least three (3)
5. List five (5) factors that can interfere with the courses of action that you can take.
communication process. Give two (2) specific
11. List six (6) stress-reducing techniques that you
examples for each factor.
find beneficial. State why they help you reduce
6. Differentiate between objective and subjective stress.
observations. List two (2) examples for each
12. Differentiate between short- and long-term
type of observation.
goals. How are they related? How are they
7. A patient is admitted to a hospital to give birth different?
to her baby. Identify at least ten (10) health care
13. What are the main goals of time management?
professionals who may be on the team that
provide her care. Review the many careers in
Chapter 3 to prepare your list.
CHAPTER 5 Legal and Ethical
Responsibilities
Chapter Objectives
Observe Standard
Precautions
◆ Provide one example of a situation that might
result in legal action for each of the following:
malpractice; negligence; assault and battery;
Instructor’s Check—Call invasion of privacy; false imprisonment;
Instructor at This Point abuse; and defamation
◆ Describe how contract laws affect health care
Caution
◆ Define privileged communications and explain
how they apply to health care
◆ State the legal regulations that apply to health
on Federal Law
care records
◆ Define HIPAA and explain how it provides
confidentiality for health care information
Math Skill
◆ List at least six basic rules of ethics for health
care personnel
◆ List at least six rights of the patient who is
receiving health care
Science Skill
◆ Justify at least eight professional standards by
explaining how they help meet legal/ethical
Career Information requirements
Technology
104 CHAPTER 5
KEY TERMS
abuse Durable Power of Attorney living wills
advance directives (POA) malpractice
agent ethics (eth"-iks) negligence (neg"-lih-gents)
assault and battery expressed contracts Patient Self-Determination
civil law false imprisonment Act (PSDA)
confidentiality (con!-fih-den- health care records Patient’s Bill of Rights
chee!-ahl"-ih-tee) implied contracts patients’ rights
contract informed consent privileged communications
criminal law invasion of privacy Resident’s Bill of Rights
defamation legal slander
(deff!-ah-may"-shun) legal disability tort
Designation of Health Care libel (ly"-bull)
Surrogate
5:1 INFORMATION property, or society; examples include practic-

ing in a health profession without having the
Legal Responsibilities required license, illegal possession of drugs,
misuse of narcotics, theft, sexual assault, and
murder
INTRODUCTION ♦ Civil law : focuses on the legal relationships
between people and the protection of a per-
In every aspect of life, there are certain laws and son’s rights; in health care, civil law usually
legal responsibilities formulated to protect you involves torts and contracts
and society. An excellent example is the need to
obey traffic laws when driving a motor vehicle. A
worker in any health career also has certain
responsibilities. Being aware of and following
TORTS
legal regulations is important for your own pro- A tort is a wrongful act that does not involve a
tection, the protection of your employer, and the contract. It is called a civil wrong instead of a
safety and well-being of the patient. crime. A tort occurs when a person is harmed or
Legal responsibilities are those that are injured because a health care provider does not
authorized or based on law. A law is a rule that meet the established or expected standards of
must be followed. Laws are created and enforced care. Many different types of torts can lead to
by the federal, state, or local government. Health legal action. These offenses may be quite com-
care workers must follow any laws that affect plex and may be open to different legal interpre-
health care. In addition, health care professionals/ tations. Some of the more common torts include
workers are also required to know and follow the the following:
state laws that regulate their respective licenses or
♦ Malpractice: Malpractice can be interpreted
registrations or set standards for their respective
as “bad practice” and is commonly called
professions. Failure to meet your legal responsi-
“professional negligence.” It can be defined as
bilities can result in legal action against you and
the failure of a professional to use the degree
your employer.
of skill and learning commonly expected in
Two main types of laws affect health care
that individual’s profession, resulting in injury,
workers: criminal laws and civil laws.
loss, or damage to the person receiving care.
♦ Criminal law : focuses on behavior known as Examples might include a physician not
crime; deals with the wrongs against a person, administering a tetanus injection when a
Legal and Ethical Responsibilities 105
patient has a puncture wound, or a nurse per- sent is permission granted voluntarily by a
forming minor surgery without having any person who is of sound mind after the proce-
training. dure and all risks involved have been explained
♦ Negligence: Negligence can be described as in terms the person can understand. It is
failure to give care that is normally expected of important to remember that a person has the
a person in a particular position, resulting in right to withdraw consent at any time. There-
injury to another person. Examples include fore, all procedures must be explained to the
falls and injuries that occur when siderails are patient, and no procedure should be per-
left down (figure 5-1), using or not reporting formed if the patient does not give consent.
defective equipment, infections caused by the ♦ Invasion of privacy : Invasion of privacy
use of nonsterile instruments and/or supplies, includes unnecessarily exposing an individual
and burns caused by improper heat or radia- or revealing personal information about an
tion treatments. individual without that person’s consent.
♦ Assault and battery : Assault includes a Examples include improperly draping or cov-
threat or attempt to injure, and battery ering a patient during a procedure so that
includes the unlawful touching of another other patients or personnel can see the patient
person without consent. They are closely exposed; sending information regarding a
related and often used together. Examples of patient to an insurance company without the
assault and battery include performing a pro- patient’s written permission; or informing the
cedure after a patient has refused to give per- news media of a patient’s condition without
mission, threatening a patient, and improper the patient’s permission.
handling or rough treatment of a patient while ♦ False imprisonment: False imprisonment
providing care. refers to restraining an individual or restrict-
It is important to remember that patients ing an individual’s freedom. Examples include
must give consent for any care, and that they keeping patients hospitalized against their
have the right to refuse care. Some procedures will, or applying physical restraints without
or practices require written consent from the proper authorization or with no justification.
patient. Examples can include surgery, certain It is important to remember that patients
diagnostic tests, experimental procedures, have the right to leave a hospital or health care
treatment of minors (individuals younger than facility without a physician’s permission. If
legal age, which varies from state to state), and this occurs, the patient is usually asked to sign
even simple things such as siderail releases for an AMA (Against Medical Advice) form. If the
a patient who wants siderails left down when patient refuses to sign the form, this must be
other factors indicate siderails should be up to documented in the patient record and the
protect the patient. Verbal consent is permit- physician must be notified.
ted in other cases, but the law states that this Physical restraints, devices used to limit a
must be “informed consent.” Informed con- patient’s movements, are discussed in detail
in Chapter 21:12. They should be used only to
protect patients from harming themselves or
others and when all other measures to control
the situation have failed. A physician’s order
must be obtained before they are used, and
strict guidelines must be observed while they
are in use.
♦ Abuse: Abuse includes any care that results in
physical harm, pain, or mental anguish. Exam-
ples of types of abuse include:
♦ Physical abuse: hitting, forcing people against
FIGURE 5-1 A nurse assistant could be charged their will, restraining movement, depriving
with negligence if a patient is injured by falling out of people of food or water, and/or not providing
bed because siderails are not raised. physical care
106 CHAPTER 5
♦ Verbal abuse: speaking harshly, swearing or ernment agency when laboratory results are inac-
shouting, using inappropriate words to curate, telling others that a person has a drug
describe a person’s race or nationality, and/or problem when another medical condition actually
writing threats or abusive statements exists, or saying that a co-worker is incompetent.
♦ Psychological abuse: threatening harm; deny-
ing rights; belittling, intimidating, or ridicul-
ing the person; and/or threatening to reveal
information about the person
CONTRACTS
♦ Sexual abuse: any unwanted sexual touching In addition to tort laws, contract laws also affect
or act, using sexual gestures, and/or suggest- health care. A contract is an agreement between
ing sexual behavior two or more parties. Most contracts have three
parts:
Patients may experience abuse before enter-
♦ Offer: a competent individual enters into a
ing a health care facility. Domestic abuse occurs
relationship with a health care provider and
when an intimate partner uses threatening,
offers to be a patient
manipulative, aggressive, or violent behavior to
maintain power and control over another person. ♦ Acceptance: the health care provider gives an
If abuse is directed toward a child, it is child appointment or examines or treats the
abuse. If it is directed toward an older person, it is patient
elder abuse. Health care providers must be alert ♦ Consideration: the payment made by the
to the signs and symptoms that may indicate patient for the services provided
patients in their care are victims of abuse. These
Contracts in health care are implied or
may include:
expressed. Implied contracts are those obliga-
♦ unexplained bruises, fractures, burns, or inju- tions that are understood without verbally
ries expressed terms. For example, when a qualified
health worker prepares a medication and a
♦ signs of neglect such as poor personal
patient takes the medication, it is implied that
hygiene
the patient accepts this treatment. Expressed
♦ irrational fears or a change in personality contracts are stated in distinct and clear lan-
♦ aggressive or withdrawn behavior guage, either orally or in writing. An example is a
♦ patient statements that indicate abuse or surgery permit. Promises of care must be kept.
neglect Therefore, all risks associated with treatment
must be explained completely to the patient (fig-
Many of the other torts can lead to charges of ure 5-2).
abuse, or a charge of abuse can occur alone. Laws All parties entering into a contract must be
in all states require that any form of abuse be free of legal disability. A person who has a legal
reported to the proper authorities. Even though disability does not have the legal capacity to form
the signs and symptoms do not always mean a a contract. Examples of people with legal disabil-
person is being abused, their presence indicates ities are minors (individuals under legal age),
a need for further investigation. Health care work- mentally incompetent persons, individuals under
ers are required to report any signs or symptoms the influence of drugs that alter the mental state,
of abuse to their immediate supervisor or to the and semiconscious or unconscious people. In
individual in the health care facility responsible such cases, parents, guardians, or others permit-
for reporting the suspicions to the proper author- ted by law must form the contract for the indi-
ities. vidual.
Defamation: Defamation occurs when false A contract requires that certain standards of
statements either cause a person to be ridiculed or care be provided by competent, qualified indi-
damage the person’s reputation. Incorrect infor- viduals. If the contract is not performed accord-
mation given out in error can result in defamation. ing to agreement, the contract is breached. Failure
If the information is spoken, it is slander; if it is to provide care and/or giving improper care on
written, it is libel. Examples include reporting the part of the health provider, or failure on the
that a patient has an infectious disease to a gov- part of the patient to pay according to the consid-
PRIVILEGED
COMMUNICATIONS
Privileged communications are another
important aspect of legal responsibility. Priv-
ileged communications comprise all information
given to health care personnel by a patient; by law,
this information must be kept confidential and
shared only with other members of the patient’s
health care team. It cannot be told to anyone else
without the written consent of the patient. The
consent should state what information is to be
released, to whom the information should be
given, and any applicable time limits. Certain
information is exempt by law and must be reported.
Examples of exempt information are births and
deaths; injuries caused by violence (such as assault
and battery, abuse, stabbings) that may require
police involvement; drug abuse; communicable
FIGURE 5-2 All risks of treatment must be
diseases; and sexually transmitted diseases.
explained to a patient before asking the patient for
permission to administer treatment.
Health care records are also considered
privileged communications. Such records
contain information about the care provided to
the patient. Although such records belong to the
eration, can be considered breach of contract and health care provider (for example, the physician,
cause for legal action. dentist, hospital, long-term care facility), the
To comply with legal mandates, an inter- patient has a right to obtain a copy of any infor-
preter/translator must be used when a con- mation in the record. Health care records can be
tract is explained to a non-English-speaking used as legal records in a court of law. Erasures
individual. In addition, many states require the are therefore not allowed on such records. Errors
use of interpreter services for individuals who are should be crossed out with a single line so mate-
deaf or hard of hearing. Most health care agen- rial is still readable. Correct information should
cies have a list of interpreters who can be used in then be inserted, initialed, and dated. If neces-
these situations. At times, an English-speaking sary, an explanation for the correction should
relative or friend of the patient can also serve as also be provided. Health care records must be
an interpreter. properly maintained, kept confidential, and
A final important consideration in contract retained for the amount of time required by state
law is the role of the agent. When a person works law (figure 5-3). When records are destroyed after
under the direction or control of another person, the legal time for retention, they should be burned
the employer is called the principal, and the or shredded to maintain confidentiality.
person working under the employer is called The growing use of computerized records has
the agent. The principal is responsible for the created a dilemma in maintaining confidentiality
actions of the agent and can be required to pay or (figure 5-4). In a large health care facility such as a
otherwise compensate people who have been hospital, many different individuals may have
injured by the agent. For example, if a dental access to a patient’s records. For this reason, health
assistant tells a patient “your dentures will look care providers are creating safeguards to maintain
better than your real teeth,” the dentist may have computer confidentiality. Some examples include
to compensate the patient financially should this limiting personnel who have access to such
statement prove false. Health care workers should records, using codes to prevent access to certain
therefore be aware of their role as agents of their information, requiring passwords to access spe-
employers and work to protect the interests of cific information on records, and constantly mon-
their employers. itoring and evaluating computer use.
108 CHAPTER 5
ability Act (HIPAA) of 1996, Congress required the

U.S. Department of Health and Human Services
(USDHHS) to establish standards to protect
health information. The USDHHS published the
Standards for Privacy of Individually Identifiable
Health Information (commonly called the Pri-
vacy Rule), which went into effect in 2003. These
standards provide federal protection for privacy
of health information in all states.
HIPAA regulations in the Privacy Rule require
every health care provider to inform patients
about how their health information is used.
Patients must sign a consent form (figure 5-5)
ascertaining that they have received the infor-
mation before any health care provider can
use the health information for diagnosis, treat-
ment, billing, insurance claims, or quality care
assessments.
FIGURE 5-3 Confidentiality must be maintained In addition, before a health care provider can
with regard to health care records. release information to anyone else, such as
another health care provider, attorney, insurance
company, federal or state agency, or even other
members of the patient’s family, a patient must
sign an authorization form for the release of this
information (figure 5-6). This authorization form
must identify the purpose or need for the infor-
mation, the extent of the information that may be
released, any limits on the release of information,
the date of authorization, and the signature of
the person authorized to give consent. These
requirements are used to ensure the privacy and
confidentiality of a patient’s health care informa-
tion. The only exception to these regulations is
for the release of information on diseases or inju-
ries that must be reported by law to protect the
safety and welfare of the public. Examples of
exempt information include births, deaths, inju-
ries caused by violence that require police
involvement, communicable diseases, and sexu-
ally transmitted diseases.
Other requirements of the privacy standards
are that patients must be:
FIGURE 5-4 The growing use of computerized
records has created the need for limiting access to ♦ able to see and obtain copies of their medical
computers to maintain confidentiality. records
♦ given information by health care providers
about how they use medical information
PRIVACY ACT ♦ allowed to set limits on how personal health
The federal government is concerned about pro- information is used
tecting privileged communications and main- ♦ permitted to request that health care provid-
taining confidentiality of health care records. In ers take reasonable care to keep communica-
the Health Insurance Portability and Account- tions confidential
FIGURE 5-5 Example of a Health Insurance Portability and Accountability Act (HIPAA) required form
providing consent to the use and disclosure of health information.
110 CHAPTER 5
FIGURE 5-6 Example of an authorization to release health information form.
♦ given the right to state who has access to their Health care providers must be aware of these
information, and even limit providing infor- standards and make every effort to protect the
mation to their family privacy and confidentiality of a patient’s health
care information.
♦ provided with information on how to file a
complaint against a health care provider who
violates the privacy act
♦ If a person can benefit from marijuana, should

SUMMARY a physician be allowed to prescribe it as a
Legal responsibilities are important aspects of treatment?
health care. All states have rules and regulations ♦ Should animals be used in medical research
governing health care. In addition, most health even if it results in the death of the animal?
care agencies have specific rules, regulations, and ♦ Should genetic researchers be allowed to
standards that determine activities performed by transplant specific genes to create the “per-
individuals holding different positions of employ- fect” human being?
ment. Standards can vary from state to state, and
even from agency to agency. It is important to
♦ Should human beings be cloned?
remember that you are liable, or legally respon- ♦ Should aborted embryos be used to obtain
sible, for your own actions regardless of what stem cells for research, especially since scien-
anyone tells you or what position you hold. tists may be able to use the stem cells to cure
Therefore, when you undertake a particular posi- diseases such as diabetes, osteoporosis, and
tion of employment in a health agency, it is your Parkinson’s?
responsibility to learn exactly what you are legally Although there are no easy answers to any of
permitted to do, and to familiarize yourself with these questions, some guidelines are provided by
your exact responsibilities. an ethical code. Most of the national organiza-
tions affiliated with the different health care
5:2 INFORMATION occupations have established ethical codes for
personnel in their respective occupations.
Ethics Although such codes differ slightly, most contain
Legal responsibilities are determined by law. Eth- the same basic principles:
ics are a set of principles relating to what is mor- ♦ Put the saving of life and the promotion of
ally right or wrong. Ethics provide a standard of health above all else.
conduct or code of behavior. This allows a health ♦ Make every effort to keep the patient as com-
care provider to analyze information and make fortable as possible and to preserve life when-
decisions based on what people believe is right ever possible.
and good conduct. Modern health care advances,
however, have created many ethical dilemmas ♦ Respect the patient’s choice to die peacefully
for health care providers. Some of these dilem- and with dignity when all options have been
mas include: discussed with the patient and family and/or
predetermined by advance directives.
♦ Is euthanasia (assisted death) justified in cer-
tain patients? ♦ Treat all patients equally, regardless of race,
religion, social or economic status, sex, or
♦ Should a patient be told that a health care pro- nationality. Bias, prejudice, and discrimina-
vider has AIDS? tion have no place in health care.
♦ Should aborted fetuses be used for research? ♦ Provide care for all individuals to the best of
♦ When should life support be discontinued? your ability.
♦ Do parents have a religious right to refuse a ♦ Maintain a competent level of skill consistent
life-saving blood transfusion for their child? with your particular occupation.
♦ Can a health care facility refuse to provide ♦ Stay informed and up to date, and pursue
expensive treatment such as a bone marrow continuing education as necessary.
transplant if a patient cannot pay for the treat-
ment? ♦ Maintain confidentiality. Confidenti-
ality means that information about the
♦ Who decides whether a 75-year-old patient or patient must remain private and can be shared
a 56-year-old patient gets a single kidney avail- only with other members of the patient’s
able for transplant? health care team. A legal violation can occur if
♦ Should people be allowed to sell organs for a patient suffers personal or financial damage
use in transplants? when confidential information is shared with
112 CHAPTER 5
others, including family members. Informa-

tion obtained from patients should not be
repeated or used for personal gain. Gossiping
about patients is ethically wrong.
♦ Refrain from immoral, unethical, and illegal
practices. If you observe others taking part in
illegal actions, report such actions to the
proper authorities.
♦ Show loyalty to patients, co-workers, and
employers. Avoid negative or derogatory state-
ments, and always express a positive attitude.
♦ Be sincere, honest, and caring. Treat others as
you want to be treated. Show respect and con-
cern for the feelings, dignity, and rights of
others.
When you enter a health occupation, learn
the code of ethics for that occupation. Make every
effort to abide by the code so as to become a com- FIGURE 5-7 Patients have the right to refuse
petent and ethical health care worker. In doing treatment.
so, you will earn the respect and confidence of
patients, co-workers, and employers. ♦ Reasonable response to a request for services
♦ Obtain information regarding any relation-
5:3 INFORMATION ship of the hospital to other health care and
educational institutions
Patients’ Rights ♦ Be advised of and have the right to refuse to
Federal and state legislation requires health participate in any research project
care agencies to have written policies con- ♦ Expect reasonable continuity of care
cerning patients’ rights, or the factors of care
that patients can expect to receive. Agencies
♦ Review medical records and examine bills and
receive an explanation of all care and charges
expect all personnel to respect and honor these
rights. ♦ Be informed of any hospital rules, regulations,
The American Hospital Association has and/or policies and the resources available to
affirmed a Patient’s Bill of Rights that is recog- resolve disputes or grievances
nized and honored by many health care facilities. Residents in long-term care facilities are
This bill of rights states, in part, that a patient has guaranteed certain rights under the Omni-
the right to: bus Budget Reconciliation Act (OBRA) of 1987.
♦ Considerate and respectful care Every long-term care facility must inform resi-
♦ Obtain complete, current information con- dents or their guardians of these rights and a copy
cerning diagnosis, treatment, and prognosis must be posted in each facility. This is often called
(expected outcome) a Resident’s Bill of Rights and states, in part,
that a resident has the right to:
♦ Receive information necessary to give
informed consent prior to the start of any pro- ♦ Free choice regarding physician, treatment,
cedure or treatment care, and participation in research
♦ Have advance directives for health care and/ ♦ Freedom from abuse and chemical or physical
or refuse treatment to the extent permitted restraints
under law (figure 5-7) ♦ Privacy and confidentiality of personal and
♦ Privacy concerning a medical care program clinical records
♦ Confidential treatment of all communications ♦ Accommodation of needs and choice regard-
and records ing activities, schedules, and health care
♦ Voice grievances without fear of retaliation or

discrimination
5:4 INFORMATION
♦ Organize and participate in family/resident Advance Directives
groups and in social, religious, and commu- for Health Care
nity activities
Advance directives for health care, also
♦ Information on medical benefits, medical known as legal directives, are legal docu-
records, survey results, deficiencies of the facil- ments that allow individuals to state what medi-
ity, and advocacy groups including the ombuds- cal treatment they want or do not want in the
man program (state representative who checks event that they become incapacitated and are
on resident care and violation of rights) unable to express their wishes regarding medical
♦ Manage personal funds and use personal pos- care. Two main directives are a living will and a
sessions Designation of Health Care Surrogate or a Dura-
ble Power of Attorney (POA) for Health Care.
♦ Unlimited access to immediate family or rela-
Living wills (figure 5-9) are documents that
tives and to share a room with his or her
allow individuals to state what measures should
spouse, if both are residents (figure 5-8)
or should not be taken to prolong life when their
♦ Remain in the facility and not be transferred conditions are terminal (death is expected). The
or discharged except for medical reasons, the document must be signed when the individual is
welfare of the resident or others, failure to pay, competent and witnessed by two adults who can-
or if the facility either cannot meet the resi- not benefit from the death. Most states now have
dent’s needs or ceases to operate laws that allow the withholding of life-sustaining
All states have adopted these rights, and some procedures and that honor living wills. A living
have added additional rights. It is important to will frequently results in a Do Not Resuscitate
check state law and obtain a list of rights estab- (DNR) order for a terminally ill individual. The
lished in your state. Health care workers can face DNR order means that cardiopulmonary resusci-
job loss, fines, and even imprisonment if they do tation is not performed when the patient stops
not follow and grant established patients’ or resi- breathing. The patient is allowed to die with
dents’ rights. By observing these rights, the health peace and dignity. At times this is extremely dif-
care worker helps ensure the patient’s safety, pri- ficult for health care workers to honor. It is impor-
vacy, and well-being, and provides quality care at tant to remember that many individuals believe
all times. that the quality of life is important and a life on
support systems has no meaning or purpose for
them.
A Designation of Health Care Surrogate,
also called a Durable Power of Attorney (POA)
for Health Care, is a document that permits an
individual (known as a principal) to appoint
another person (known as an agent) to make any
decisions regarding health care if the principal
should become unable to make decisions (figure
5-10). This includes providing or withholding
specific medical or surgical procedures, hiring or
dismissing health care providers, spending or
withholding funds for health care, and having
access to medical records. Although they are most
frequently given to spouses or adult children,
POAs can be given to any qualified adult. To meet
legal requirements, the POA must be signed by
the principal, agent, and one or two adult wit-
FIGURE 5-8 A married couple in a long-term care nesses.
facility has the legal right to share a room if both A federal law, called the Patient Self-Deter-
members of the couple are residents in the facility. mination Act (PSDA) of 1990, mandates that all
114 CHAPTER 5
FLORIDA LIVING WILL – PAGE 1 OF 2

INSTRUCTIONS
PRINT THE DATE Declaration made this _______ __ day of _________________, ________,
(day) (month) (year)
PRINT YOUR NAME I, _____________________________________________________,

willfully and voluntarily make known my desire that my dying not be
artificially prolonged under the circumstances set forth below, and I do
hereby declare that :
PLEASE INITIAL If at any time I am incapacitated and

EACH THAT APPLIES
______ I have a terminal condition, or
______ I have an end-stage condition, or
______ I am in a persistent vegetative state
and if my attending or treating physician and another consulting physician
have determined that there is no reasonable medical probability of my
recovery from such condition, I direct that life-prolonging procedures be
withheld or withdrawn when the application of such procedures would
serve only to prolong artificially the process of dying, and that I be
permitted to die naturally with only the administration of medication or
the performance of any medical procedure deemed necessary to provide
me with comfort care or to alleviate pain.
It is my intention that this declaration be honored by my family and

physician as the final expression of my legal right to refuse medical or
surgical treatment and to accept the consequences for such refusal. In the
event that I have been determined to be unable to provide express and
informed consent regarding the withholding, withdrawal, or continuation
of life-prolonging procedures, I wish to designate, as my surrogate to
carry out the provision of this declaration:
Name:
__________________________________
PRINT THE NAME,
HOME ADDRESS
AND TELEPHONE Address: __________________________________
NUMBER OF YOUR
SURROGATE _______________________________________ Zip Code: __________________________________
© 2005 National
Phone:
Hospice and __________________________________
Palliative Care
Organization
2006 Revised
FLORIDA LIVING WILL - PAGE 2 OF 2
I wish to designate the following person as my alternate surrogate, to carry

out the provisions of this declaration should my surrogate be unwilling or
unable to act on my behalf:
PRINT NAME, HOME Name: _________________________________

ADDRESS
AND TELEPHONE Address: _________________________________
NUMBER OF YOUR _________________________________ Zip Code: _________________________________
ALTERNATE
SURROGATE
Phone:
_________________________________
ADD PERSONAL Additional instructions (optional):

INSTRUCTIONS
(IF ANY)
SIGN THE I understand the full import of this declaration, and I am emotionally and
DOCUMENT mentally competent to make this declaration.
Signed:
________________________
WITNESSING Witness 1:
PROCEDURE
Signed: ________________________
Address: ________________________
TWO WITNESSES
MUST SIGN AND
PRINT THEIR Witness 2:
ADDRESSES
Signed: ________________________
Address: ________________________
© 2005 National
Hospice and Courtesy of Caring Connections
Palliative Care 1700 Diagonal Road, Suite 625, Alexandria, VA 22314
Organization www.caringinfo. , 800/658-8898
2006 Revised
FIGURE 5-9 A living will is a legal document that FIGURE 5-10 A designation of health care
allows an individual to state what measures should surrogate is a legal document that allows an indi-
or should not be taken to prolong life. (Copyright © vidual to appoint another person to make health
2005 National Hospice and Palliative Care Organi- care decisions if the individual is unable to make his
zation. All rights reserved. Reproduction and or her own decisions. (Copyright © 2005 National
distribution by an organization or organized group Hospice and Palliative Care Organization. All rights
without the written permission of the National reserved. Reproduction and distribution by an
Hospice and Palliative Care Organization is organization or organized group without the written
expressly forbidden. For more information, please permission of the National Hospice and Palliative
visit our Web site at www.caringinfo.org) Care Organization is expressly forbidden. For
more information, please visit our Web site at
www.caringinfo.org)
health care facilities receiving any type of federal ♦ Use approved, correct methods while perform-
aid comply with the following requirements: ing any procedure. Follow specific methods
♦ Inform every adult, both orally and in writing, taught by qualified instructors in educational
of their right under state law to make deci- facilities, or observe and learn procedures
sions concerning medical care, including the from your employer or authorized personnel.
right to refuse treatment and right-to-die Most health care agencies have an approved
options procedure manual that explains the step-by-
step methods for performing tasks. Use this
♦ Provide information and assistance in prepar- manual or read the manufacturer’s instruc-
ing advance directives
tions on specific equipment or supplies.
♦ Document any advance directives on the ♦ Obtain proper authorization before perform-
patient’s record
ing any procedure. In some health careers, you
♦ Provide written statements to implement the will obtain authorization directly from the
patient’s rights in the decision-making pro- doctor, therapist, or individual in charge of a
cess patient’s care. In other careers, you will obtain
♦ Affirm that there will be no discrimination or authorization by checking written orders (fig-
effect on care because of advance directives ure 5-11). In careers where you have neither
access to patients’ records nor direct contact
♦ Educate the staff on the medical and legal with the individuals in charge of care, an
issues of advance directives
immediate supervisor will interpret orders
The PSDA ensures that patients are informed and then direct you to perform procedures.
of their rights and have the opportunity to deter- ♦ Identify the patient. In some health care agen-
mine the care they will receive. cies, patients wear identification bands. If this
All health care workers must be aware of and is the case, check this name band (figure
honor advance or legal directives. In addition, 5-12). In addition, state the patient’s name
health care workers should give serious consider- clearly, repeating it if necessary. For example,
ation to preparing their own advance directives. say “Miss Jones?” followed by “Miss Sandra
Jones?” to be sure you have the correct patient.
5:5 INFORMATION Some health care facilities now use bar codes
on patient identification bands. A scanner is
Professional Standards
Legal responsibilities, ethics, patients’ rights, and
advance directives all help determine the type of
care provided by health care workers. By follow-
ing certain standards at all times, you can protect
yourself, your employer, and the patient. Some of
the basic standards are as follows:
♦ Perform only those procedures for which you
have been trained and are legally permitted to
do. Never perform any procedure unless you
are qualified. The necessary training may be
obtained from an educational facility, from
your employer, or in special classes provided by
an agency. If you are asked to perform any pro-
cedure for which you are not qualified, it is
your responsibility to state that you have not
been trained and to refuse to do it until you
receive the required instruction. If you are not
legally permitted to either perform a procedure
or to sign documents, it is your responsibility to FIGURE 5-11 Obtain proper authorization before
refuse to do so because of legal limitations. performing any procedure on a patient.
116 CHAPTER 5
contained in the records without proper

authorization and patient consent. If you are
reporting specific information about a patient
to your immediate supervisor, ensure that
your conversation cannot be heard by others.
Avoid discussing patients with others at home,
in social situations, in public places, or any-
where outside the agency.
♦ Think before you speak and carefully con-
sider everything you say. Do not reveal
information, such as a blood pressure reading,
to the patient unless you are specifically
instructed to do so.
♦ Treat all patients equally regardless of race,
religion, social or economic status, sex, or
nationality. Provide care for all individuals to
the best of your ability.
♦ Accept no tips or bribes for the care you pro-
FIGURE 5-12 If a name band is present, use it to vide. You receive a salary for your services, and
identify the patient. the care you provide should not be influenced
by the amount of money a patient can afford
used to check the bar code and verify the to pay. A polite refusal, such as “I’m sorry, I am
identification of the patient. not allowed to accept tips,” is usually the best
♦ Obtain the patient’s consent before performing way to handle this situation.
any procedure. Always explain a procedure ♦ If any error occurs or you make a mistake,
briefly or state what you are going to do, and report it immediately to your supervisor. Never
obtain the patient’s consent. It is best to avoid try to hide or ignore an error. Make every
statements such as “May I take your blood effort to correct the situation as soon as pos-
pressure?” because the patient can say “No.” By sible, and take responsibility for your actions.
stating, “The doctor would like me to check ♦ Behave professionally in dress, language, man-
your blood pressure,” you are identifying the ners, and actions. Take pride in your occupa-
procedure and obtaining consent by the tion and in the work you do. Promote a positive
patient’s acceptance and/or lack of objection. attitude at all times.
If a patient refuses to allow you to perform a
procedure, check with your immediate super- Even when standards are followed, errors
visor. Some procedures require written consent leading to legal action sometimes still occur. Lia-
from the patient. Follow the agency policy with bility insurance constitutes an additional form of
regard to such procedures. Never sign your protection in such cases. Many insurance com-
name as a witness to any written consent or panies offer policies at reasonable cost for health
document unless you are authorized to do so. care workers and students. Some companies will
even issue liability protection under a homeown-
♦ Observe all safety precautions. Handle er’s policy or through a liability policy that pro-
equipment carefully. Be alert to all tects the person against all liabilities, not just
aspects of safety to protect the patient. Know those related to occupation.
and follow safety rules and regulations. Be Again, remember that it is your responsibil-
alert to safety hazards in any area and make ity to understand the legal and ethical impli-
every effort to correct or eliminate such haz- cations of your particular health career. Never
ards as quickly as possible. hesitate to ask specific questions or to request
♦ Keep all information confidential. This written policies from your employer. Contact
includes oral and written information. Ensure your state board of health or state board of edu-
that you do not place patient records in any cation to obtain information regarding regula-
area where they can be seen by unauthorized tions and guidelines for your occupation. By
individuals. Do not reveal any information obtaining this information and by following the

Frozen stem cells that cure major diseases?
Stem cells are a major area of research today. Stem cells are important because they can
become any of the specialized cell types needed in the human body. They can turn into
muscle cells in the heart, nerve cells in the brain, or cells that secrete the insulin needed by
a patient with diabetes. The major sources of stem cells are a developing embryo (infant);
adult tissues such as bone marrow, brain, muscle, skin, and liver; and blood from the umbil-
ical cord of a newborn infant.
Scientists the world over are finding ways to grow stem cells and force them to generate
special cells that can be used to treat injury or disease. Early research has proved it is easier
to work with embryonic cells, but this has created ethical dilemmas because it means
embryos are destroyed. However, if adult cells can be harvested and grown, it would be eas-
ier to use an adult’s own cells because they would not be rejected by the body.
Many scientists believe that, eventually, the study of stem cells will help explain how
cells grow and develop. Conditions such as cancer and birth defects are caused by abnormal
cell division. If scientists can learn how the abnormal development occurs, they could find
ways to treat and even prevent the conditions. Major research is directed toward learning
what makes the cells specialize to become a specific type of cell in the body.
Currently, parents have the option of preserving umbilical cord blood for its stem cells.
When their baby is born, blood from the umbilical cord can be collected and stored in liquid
nitrogen. If the child later develops a disease such as cancer and needs stem cells, the cells
can be recovered and used for the transplant. The cost of this procedure still limits its wide-
spread use, but hopefully less expensive methods will be found to maintain this source of
stem cells. Many stem cell transplants have already been performed successfully, and lives
have been saved.
basic standards listed, you will protect yourself, two or more parties. Contracts create obliga-
your employer, and the patient to whom you pro- tions that must be met by all involved individu-
vide health care. als. If a contract is not performed according to
agreement, the contract is breached, and legal
STUDENT: Go to the workbook and complete action can occur.
the assignment sheet for Chapter 5, Legal and Eth- Understanding privileged communications
ical Responsibilities. is another important aspect of legal responsibili-
ties. A health care worker must be aware that all
information given by a patient is confidential and
CHAPTER 5 SUMMARY should not be told to anyone other than mem-
bers of the patient’s health care team without
the written consent of the patient. Health care
All health care workers have legal and ethical records are also privileged communications and
responsibilities that exist to protect the health can be used as legal records in a court of law.
care worker and employer, and to provide for the Ethical responsibilities are based not on law,
safety and well-being of the patient. but rather, on what is morally right or wrong.
Legal responsibilities in health care usually Most health care occupations each have an estab-
involve torts and contracts. Torts are wrongful lished code of ethics that provides a standard of
acts that do not involve contracts. Examples of conduct or code of behavior. Health care workers
torts that can lead to legal action include mal- should make every effort to abide by the codes of
practice, negligence, assault and battery, inva- ethics established for their given professions.
sion of privacy, false imprisonment, abuse, and Health care workers must respect patients’
defamation. A contract is an agreement between rights. Health care agencies have written poli-
118 CHAPTER 5
cies concerning the factors of care that patients care surrogate or durable power of attorney for
can expect to receive. All personnel must respect health care; compare the different forms.
and honor these rights. 7. Patient Self Determination Act of 1990 : locate a
Advance directives for health care are legal copy of this act or information on the purposes
documents that allow individuals to state what of this act (Hint: check federal legislation Web
medical treatment they want or do not want in sites).
the event that they become incapacitated. Two
main examples are a living will and a Designa- 8. Insurance: search for different types of liability
tion of Health Care Surrogate or Durable Power insurance for health care providers; determine
of Attorney for Health Care. As a result of a feder- what different policies cover and their cost.
al law called the Patient Self-Determination Act
(PSDA), any health care facility receiving federal
funds must provide patients with information REVIEW QUESTIONS
regarding and assistance in preparing advance
or legal directives. 1. Choose a specific health care profession (i.e.,
Professional standards of care help provide dental hygienist, physical therapist) and create
guidelines for meeting legal responsibilities, eth- a situation where this individual might be
ics, and patients’ rights. Every health care worker subject to legal action for each of the following
should follow these standards at all times. In ad- torts: malpractice, negligence, assault, battery,
dition, all health care workers should know and invasion of privacy, false imprisonment, abuse,
follow the state laws that regulate their respec- and defamation.
tive occupations.
2. Differentiate between slander and libel.
3. What is the difference between an implied
INTERNET SEARCHES contract and an expressed contract?
Use the suggested search engines in Chapter 12:4 4. You are employed as a geriatric assistant. A
of this textbook to search the Internet for addi- resident tells you that he is saving sleeping pills
tional information on the following topics: so he can commit suicide. He has terminal
cancer and is in a great deal of pain. What
1. Torts: search for additional information or
should you do? Why?
actual legal cases involving malpractice,
negligence, assault and battery, invasion of 5. What is HIPAA? Identify three (3) specific ways
privacy, false imprisonment, and defamation. that HIPAA protects the privacy and confiden-
tiality of health care information.
2. Abuse: research domestic violence or abuse,
child abuse, and elder abuse to determine how 6. Obtain at least two different codes of ethics for
victims might react, signs and symptoms indic- health professions by contacting professional
ative of abuse, and information on how to help organizations or searching the Internet.
these victims. Compare the codes of ethics.
3. Contracts: search for information on compo- 7. Mr. Gonzales is a healthy 55-year-old man with
nents of a contract and legal cases in health a living will that contains a DNR (Do Not
care caused by a breach of contract. Resuscitate) order for terminal conditions. He
goes into cardiac arrest as a result of an allergic
4. Ethics: use Internet addresses for professional
reaction to an injection of dye for a laboratory
organizations (see Chapter 3) to find two or
test. Should cardiopulmonary resuscitation
three different codes of ethics; compare and
(CPR) be started? Why or why not?
contrast the codes of ethics.
8. How does a living will differ from a Designation
5. Patient’s rights: search for complete copies of a
of Health Care Surrogate?
patient’s or resident’s bill of rights; compare
and contrast the different bills of rights (Hint: 9. List five (5) different patient or resident rights.
check American Hospital Association Web site).
10. Identify six (6) professional standards by
6. Advance directives: search for different examples explaining why they are important to meet legal
of a living will and/or a designation of health responsibilities, ethics, and/or patient’s rights.
CHAPTER 6 Medical
Terminology
Chapter Objectives
Observe Standard
Precautions
◆ Identify basic medical abbreviations selected
from a standard list
◆ Define prefixes, suffixes, and word roots
selected from a list of words
◆ Spell and pronounce medical terms correctly
Safety—Proceed with ◆ Define, pronounce, and spell all key terms
Caution
on Federal Law
Math Skill
Science Skill
Career Information
Technology
120 CHAPTER 6
KEY TERMS
abbreviations suffix word roots
prefix
6:1 INFORMATION
lewis & king, md
Using Medical Abbreviations L&K 2501 center street
northborough, oh 12345
As a health care worker, you will see many abbre-

viations. You will be expected to recognize the
most common abbreviations. This section pro- Name Juanita Hansen
vides a basic list of these abbreviations. Address 143 Gregory Lane, Apt. 43 Date 4/7/
Abbreviations are shortened forms of
!
words, usually just letters. Common examples
are AM, which means morning, and PM, which Furadantin 50 mg Tabs
means afternoon or evening.
Abbreviations are used in many health fields. #50
Sometimes they are used by themselves. At other Sig 50 mg p.o. qid
times, several abbreviations are combined to give
orders or directions. Consider the following Generic Substitution Allowed Susan Rice M.D.
examples: Dispense As Written
REPETATUR 0 1 2 3 p.r.n. M.D.
BR c– BRP, FFl qh, VS qid ✓LABEL
NPO 8 PM, To Lab for CBC, BUN, and FBS
These examples are short forms for giving FIGURE 6-1 Can you use the list of abbreviations
to interpret the prescription?
directions. The first example is interpreted as fol-
lows: bedrest with bathroom privileges, force flu-
ids every hour, vital signs four times a day. The
second example is interpreted as follows: noth- on Accreditation of Healthcare Facilities has
ing by mouth after eight o’clock in the evening, to adopted an official Do Not Use list containing
the laboratory for a complete blood count, blood abbreviations and symbols that cause problems.
urea nitrogen, and fasting blood sugar. As these Some common examples include:
examples illustrate, it is much easier to write ♦ IU: abbreviation for international unit; can be
using abbreviations than it is to write the corre- mistaken for IV (intravenous) or the number
sponding detailed messages. 10; write out international unit
Look at the sample prescription form shown ♦ qd, qod, qid: abbreviations for every day, every
in figure 6-1. Use the list of abbreviations to deter- other day, and four times a day, respectively;
mine what the prescription says. can be interchanged if written poorly; for
A sample list of abbreviations and symbols example, an every other day order could be
follows. This list contains some of the most com- done four times in one day; write out daily,
monly used abbreviations. Different abbrevia- every other day, or four times a day
tions may be used in different facilities and in
different parts of the country. It is the responsibil- ♦ cc: abbreviation for cubic centimeter; can be
ity of health care workers to learn the meanings read as “u” or “units” if written poorly; write
of the abbreviations used in the agencies where out milliliter or mL clearly because 1 cubic
they are employed. centimeter equals 1 milliliter
Some agencies are prohibiting the use of spe- ♦ Lack of leading zero (.5 mg): decimal point is
cific abbreviations or symbols because they are missed and 10 times the dose is given (5 mg
prone to causing errors. The Joint Commission instead of .5 mg); write 0.5 or 0.X mg
Medical Terminology 121
♦ @ symbol for at; mistaken for the number 2 if aa of each

written poorly; write out “at” Ab abortion
abd abdomen, abdominal
♦ < or >: symbols for less than or greater than; ABG arterial blood gas
can be misinterpreted as the number 7 or let-
ac before meals
ter L; write greater than or less than
ACLS advanced cardiac life support
♦ Apothecary unit symbols such as ! or –!: symbols ACTH adrenocorticotrophic hormone
for dram and ounce; easily mistaken for each AD right ear
other; write dram or ounce or use metric units ADH antidiuretic hormone
Health care workers must use only the abbre- ad lib as desired
viations or symbols approved by the facility in ADL activities of daily living
which they are employed. In addition, extreme adm admission
care must be used while writing abbreviations AED automated external defibrillation
and symbols so they are legible and readily under- AHA American Hospital Association
stood. AIDS acquired immune deficiency
NOTE: In the lists that follow, these abbreviations syndrome
and symbols are included because they are still used am, AM morning, before noon
in some health facilities. However, an asterisk (*) has AMA American Medical Association,
been placed in front of the abbreviation or symbol to against medical advice
alert the user that it is on the Do Not Use list. amal amalgam
NOTE: There is a growing trend toward eliminating amb ambulate, walk
periods from most abbreviations. Although the fol- amt amount
lowing list does not show periods, you may work in ANA American Nurses’ Association
an agency that chooses to use them. When in doubt, ANS autonomic nervous system
follow the policy of your agency. ant anterior
Learn the abbreviations in the following way: AP apical pulse
♦ Use a set of index cards to make a set of flash- approx approximately
cards of the abbreviations found on the abbre- aq, aqua aqueous (water base)
viation list. Print one abbreviation in big letters ARC AIDS-related complex
on each card. Put the abbreviation on the ART accredited records technician
front of the card and the meaning on the back AS left ear
of the card. as tol as tolerated
ASA aspirin (acetylsalicylic acid)
♦ Use the flashcards to study the abbreviations. ASAP as soon as possible
A realistic goal is to learn all abbreviations for ASCVD arteriosclerotic cardiovascular
one letter per week. For example, learn all of disease
the As the first week, all of the Bs the second ASHD arteriosclerotic heart disease
week, all of the Cs the third week, and so on AU both ears
until all are learned. av average
♦ Follow your instructor’s guidelines for tests on AV arteriovenous, atrioventricular
the abbreviations. Many instructors give A&W alive and well
weekly tests. The tests may be cumulative. Ax axilla, axillary, armpit
They may cover the letter of the week plus any
letters learned in previous weeks.
B
A Ba
bacti
barium
bacteriology
*@ at B&B bowel and bladder training
a before BBB bundle branch block
A&D admission and discharge B&C biopsy and conization
A&P anterior and posterior, BE barium enema
anatomy and physiology bid twice a day
122 CHAPTER 6
bil bilateral co, c/o complains of

Bl blood CO carbon monoxide, coronary
Bl Wk blood work occlusion
BM bowel movement CO2 carbon dioxide
BMI body mass index Comp complete, compound
BMR basal metabolic rate cont continued
BP blood pressure COPD chronic obstructive pulmonary
BR bed rest disease
BRP bathroom privileges COTA certified occupational therapy
BS blood sugar assistant
BSA body surface area CP cerebral palsy
BSC, bsc bedside commode CPK creatine phosphokinase (cardiac
BSE breast self-examination enzyme)
BUN blood urea nitrogen CPR cardiopulmonary resuscitation
Bx, bx biopsy CPT current procedure terminology
CRTT certified respiratory therapy
technician
C CS
C&S
central supply or service
culture and sensitivity
°C degrees Celsius (Centigrade) CSF cerebrospinal fluid
c, w/ with CSR central supply room
Ca calcium CST certified surgical technologist
CA cancer CT computerized tomography
cal calorie Cu copper
Cap capsule CVA cerebral vascular accident
CAT computerized axial tomography (stroke)
Cath catheter, catheterize CVD cardiovascular disease
CBC complete blood count Cx cervix, complication, complaint
CBET certified biomedical equipment
technician
CBR
*cc
complete bed rest
cubic centimeter
D
CC chief complaint d day
CCU coronary care unit, critical care D&C dilatation and curettage
unit DA dental assistant
CDA certified dental assistant DAT diet as tolerated
CDC Centers for Disease Control and DC Doctor of Chiropractic
Prevention D/C, dc, disc discontinue, discharge
CEO chief executive officer DDS Doctor of Dental Surgery
CF cystic fibrosis DEA Drug Enforcement Agency
CHD coronary heart disease del delivery
CHF congestive heart failure Dept department
CHO carbohydrate DH dental hygienist
chol cholesterol DHHS Department of Health and
CICU cardiac intensive care unit Human Services
ck check Diff differential white blood cell
Cl chloride or chlorine count
cl liq clear liquids dil dilute, dissolve
cm centimeter DM diabetes mellitus
CMA certified medical assistant DMD Doctor of Dental Medicine
CNP certified nurse practitioner DMS diagnostic medical sonography
CNS central nervous system DNA deoxyribonucleic acid
DNR do not resuscitate FDA Food and Drug

DO Doctor of Osteopathic Medicine Administration
DOA dead on arrival Fe iron
DOB date of birth FF, FFl force fluids
DOD date of death FH family history
DON director of nursing FHR fetal heart rate
DPM Doctor of Podiatric Medicine Fl, fl fluid
DPT diphtheria, pertussis, tetanus FSH follicle-stimulating hormone
Dr doctor ft foot
dr dram, drainage FUO fever of unknown origin
DRG diagnostic related group Fx, Fr fracture
drg, drsg, dsg dressing
D/S dextrose in saline
DSD
DTs
dry sterile dressing
delirium tremors
G
DVM Doctor of Veterinary Medicine GA gastric analysis, general
DW distilled water anesthesia
D/W dextrose in water gal gallon
Dx, dx diagnosis GB gallbladder
Gc gonococcus, gonorrhea
GH growth hormone
E GI
Gm, g
gastrointestinal
gram
ea each gr grain
EBL estimated blood loss gt, gtt, gtts drop, drops
ECG, EKG electrocardiogram GTT glucose tolerance test
ED emergency department GU genitourinary
EEG electroencephalogram Gyn gynecology
EENT ear, eye, nose, throat
elix elixir
EMG
EMS
electromyogram
emergency medical services
H
EMT emergency medical technician H hydrogen
ENT ear, nose, throat H&H hemoglobin and hematocrit
EPA Environmental Protection H2O water
Agency H2O2 hydrogen peroxide
ER emergency room H, (h), hypo hypodermic injection
ESR erythrocyte sedimentation rate HA hearing aid, headache
et, etiol etiology (cause of disease) HBP high blood pressure
Ex, exam examination HBV hepatitis B virus
Exc excision HCG human chorionic gonadotrophin
Exp exploratory, expiration hormone
ext extract, extraction, external HCl hydrochloric acid
hct hematocrit
HCV hepatitis C virus
F HDL high-density lipoproteins
(healthy type of cholesterol)
°F degrees Fahrenheit Hg mercury
FAS fetal alcohol syndrome Hgb, Hb hemoglobin
FBS fasting blood sugar HHA home health assistant/aide
FBW fasting blood work HIPAA Health Insurance Portability and
FC Foley catheter Accountability Act
124 CHAPTER 6
HIV human immunodeficiency virus Kg, kg kilogram

(AIDS virus) KUB kidney, ureter, bladder X-ray
HMO health maintenance organization
HOB head of bed
HOH
H&P
hard of hearing
history and physical
L
Hr, hr, H, h hour, hours L lumbar
HRT hormone replacement therapy L&D labor and delivery
HS hour of sleep (bedtime) L&W living and well
Ht height (L), lt, lft left
Hx, hx history L, l liter (1,000 cc)
hypo hypodermic injection Lab laboratory
Hyst hysterectomy Lap laparotomy
lat lateral
lb pound
I LCT
LDH
long-term care
lactose dehydrogenase (cardiac
I&D incision and drainage enzyme)
I&O intake and output LDL low-density lipoprotein
ICCU intensive coronary care unit (unhealthy type of cholesterol)
ICD international classification of lg large
diseases liq liquid
ICU intensive care unit LLQ left lower quadrant
ID intradermal, infectious disease LMP last menstrual period
IDDM insulin-dependent diabetes LOC laxative of choice, level of
mellitus consciousness
IH infectious hepatitis LP lumbar puncture
IM intramuscular LPN licensed practical nurse
imp impression LS lumbar sacral
in inch LTC long-term care
inf infusion, inferior, infection LUQ left upper quadrant
ing inguinal LVN licensed vocational nurse
inj injection
int internal, interior
IPPB intermittent positive pressure
breathing
M
irr, irrig irrigation m minim
Isol, isol isolation MA medical assistant
IT inhalation therapy Mat maternity
IUD intrauterine device mcg microgram
IV intravenous MD Medical Doctor, muscular
IVP intravenous pyelogram dystrophy, myocardial disease
Med medical, medicine
mEq milliequivalent
J mg
Mg
milligram
magnesium
jt joint MI myocardial infarction (heart
attack)
MICU medical intensive care unit
K min
mL, ml
minute
milliliter
K potassium MLT medical laboratory technician
KCl potassium chloride mm millimeter
MN midnight OOB out of bed

mod moderate OP outpatient
MOM milk of magnesia OPD, OPC outpatient department or clinic
MRI magnetic resonance imaging opp opposite
MS multiple sclerosis, mitral OR operating room
stenosis, muscular–skeletal Ord orderly
MT medical technologist Orth orthopedics
os mouth
OS left eye, occular sinistra
N OSHA Occupational Safety and Health
Administration
N nitrogen OT occupational therapy/therapist
N/A not applicable OTC over the counter
Na sodium OU each eye
NA nurse aide/assistant OV office visit
NaCl sodium chloride (salt) oz ounce
NB newborn
N/C no complaints
neg
Neur
negative, none
neurology
P
NG, ng, N/G nasogastric tube p after
NICU neurological intensive care unit P pulse, phosphorus
NIDDM non-insulin-dependent diabetes PA physician’s assistant
mellitus PAC premature atrial contraction
NIH National Institutes of Health PAP Papanicolaou test (smear)
nil none para number of pregnancies
NKA no known allergies Path pathology
NKDA no known drug allergies Pb lead
no number PBI protein-bound iodine
NO nursing office pc after meals
noc, noct at night, night PCA patient-controlled analgesia
NP nurse practitioner PCC poison control center
NPN nonprotein nitrogen PCP patient care plan
NPO nothing by mouth PCT patient/personal care technician
N/S, NS normal saline PDR Physicians’ Desk Reference
Nsy nursery PE physical examination,
N/V, N&V nausea and vomiting pulmonary edema
NVD nausea, vomiting, diarrhea Peds pediatrics
NVS neurological vital signs per by, through
PET positron emission tomography
pH measure of acidity/alkalinity
O Pharm
PI
pharmacy
present illness
O2 oxygen PID pelvic inflammatory disease
O&P ova and parasites PKU phenylketonuria
Ob, Obs obstetrics PM, pm after noon
OBRA Omnibus Budget Reconciliation PMC postmortem (after death) care
Act PMS premenstrual syndrome
od overdose PNS peripheral nervous system
OD right eye, occular dextra, Doctor po by mouth
of Optometry PO phone order
oint ointment post posterior, after
OJ orange juice post-op after an operation
126 CHAPTER 6
PP postpartum (after delivery) RT respiratory therapy/therapist

PPE personal protective equipment RUQ right upper quadrant
PPO preferred provider organization Rx prescription, take, treatment
pre-op before an operation
prep prepare
prn
Psy
whenever necessary, as needed
psychology, psychiatry
S
pt patient, pint (500 mL or cc) S sacral
Pt prothrombin time S&A sugar and acetone
PT physical therapy/therapist s, w/o without
PTT partial thromboplastin time SA sinoatrial
PVC premature ventricular sc, SC subcutaneous
contraction SGOT, SGPT transaminase test
PVD peripheral vascular disease SICU surgical intensive care unit
Px prognosis, physical examination SIDS sudden infant death syndrome
Sig give the following directions
sm small
Q SOB
sol
short of breath
solution
q, q every sos if necessary
*qd every day spec specimen
qh every hour SpGr, spgr specific gravity
q2h every 2 hours SPN student practical nurse
q3h every 3 hours spt spirits, liquor
q4h every 4 hours ss one half
qhs every night at bedtime S/S, S&S signs and symptoms
*qid four times a day SSE soap solution enema
qns quantity not sufficient staph staphylococcus infection
*qod every other day stat immediately, at once
qol quality of life STD sexually transmitted disease
qs quantity sufficient STH somatotropic hormone
qt quart strep streptococcus infection
supp suppository
Surg surgery, surgical
R susp
Sx
suspension
symptom, sign
R respiration, rectal syp syrup
®, Rt right
Ra radium
RBC
RDA
red blood cell
recommended daily allowance
T
REM rapid eye movement T&A tonsillectomy and
RHD rheumatic heart disease adenoidectomy
RLQ right lower quadrant T, Temp temperature
RN registered nurse tab tablet
RNA ribonucleic acid TB tuberculosis
R/O rule out tbsp tablespoon
RO reality orientation TCDB turn, cough, deep breathe
ROM range of motion TH thyroid hormone
RR recovery room TIA transient ischemic attack
RRT registered respiratory therapist, tid three times a day
registered radiologic technologist TLC tender loving care
TO telephone order
tol tolerated Y
TPN total parenteral nutrition
y/o years old
TPR temperature, pulse, respiration
YOB year of birth
tr, tinct tincture
yr year
TSH thyroid-stimulating hormone
tsp teaspoon
TUR transurethral resection
TWE tap water enema Z
tx traction, treatment, transplant Zn zinc
U MISCELLANEOUS
UA, U/A urinalysis SYMBOLS
ung ointment
Ur, ur urine *! greater than
URI upper respiratory infection *" less than
UTI urinary tract infection ↑ higher, elevate, or up
UV ultraviolet ↓ lower or down
# pound or number
*! dram
*!–
V #
ounce
foot or minute
Vag vaginal $ inch or second
VD venereal disease º degree
VDM Veterinarian Degree of Medicine " or F female
VDRL serology for syphilis, Venereal # or M male
Disease Research Laboratory I or i or Ṫ one
VO verbal order II or ii or ṪṪ two
Vol volume V five
vp venipuncture, venous pressure X ten
VS vital signs (TPR & BP) L fifty
C one hundred
D five hundred
W M one thousand
WBC white blood cell STUDENT: Go to the workbook and complete

WC ward clerk/secretary the assignment and evaluation sheets for 6:1,
w/c wheelchair Using Medical Abbreviations.
WHO World Health Organization
WNL within normal limits
w/o, wo without 6:2 INFORMATION
W/P whirlpool
wt weight
Interpreting Word Parts
Medical dictionaries have been written to include
the many words used in health occupations. It
X would be impossible to memorize all such words.
By breaking the words into parts, however, it is
x times (2x means do 2 times) sometimes possible to figure out their meanings.
x-match cross-match This section provides basic information on doing
XR X-ray just that.
128 CHAPTER 6
A word is often a combination of different meaning enlarged, the vowel o is added for hepa-
parts. The parts include prefixes, suffixes, and tomegaly.
word roots (see figure 6-2). By learning basic prefixes, suffixes, and word
A prefix can be defined as a syllable or word roots, you will frequently be able to interpret the
placed at the beginning of a word. A suffix can be meaning of a word even when you have never
defined as a syllable or word placed at the end of before encountered the word. A list of common
the word. prefixes, suffixes, and word roots follows. An
The meanings of prefixes and suffixes are set. example of a medical term using the word part
For example, the suffix itis means “inflammation and the meaning of the medical term is also pro-
of.” Tonsillitis means “an inflammation of the vided. In addition, the prefixes, suffixes, and word
tonsils,” and appendicitis means “an inflamma- roots for parts of the human body are shown in
tion of the appendix.” Note that the meaning of figure 6-3.
the suffix is usually placed first when the word is Learn the prefixes, suffixes, and word roots in
defined. the following way:
Word roots can be defined as main words or
parts to which prefixes and suffixes can be added. ♦ Use a set of index cards to make flashcards of
In the example appendicitis, the word root is the word parts found on the prefix, suffix, and
appendix. By adding the prefix pseudo-, which word root list. Place one prefix, suffix, or word
means “false,” and the suffix itis, which means root on each card. Put the word part on the
“inflammation of,” the word becomes pseudoap- front of the card and the meaning of the word
pendicitis. This is interpreted as a “false inflam- part on the back of the card. Ensure that each
mation of the appendix.” is spelled correctly.
The prefix usually serves to further define the
word root. The suffix usually describes what is ♦ Use the flashcards to learn the meanings of
happening to the word root. the word parts. A realistic goal is to learn one
When prefixes, suffixes, and/or word roots letter per week. For example, learn all word
are joined together, vowels are frequently added. parts starting with the letter A the first week,
Common examples include a, e, i, ia, io, o, and u. all of those starting with B the second week, all
These are listed in parentheses in the lists that of those starting with C the third week, and so
follow. The vowels are not used if the word root or on until all are learned. Practice correct spell-
suffix begins with a vowel. For example, encephal ing of all of the word parts.
(o) means brain. When it is combined with itis ♦ Follow your instructor’s guidelines for tests
meaning inflammation of, the vowel is not used on the word parts. Many instructors give
for encephalitis. When it is combined with gram, weekly tests. The tests may be cumulative.
meaning tracing or record, the vowel o is added They may cover the letter of the week plus
for encephalogram. Hepat (o) means liver. When any letters learned in previous weeks. Words
it is combined with itis, the vowel is not used for may be presented that use the various word
hepatitis. When it is combined with megaly, parts.
FIGURE 6-2 Prefixes, suffixes, and word roots can be used to interpret the meaning of a word.
head (cephal/o)
skull (crani/o)
(ophthalm/o; ocul/o) eye
brain (cerebr/o; encephal/o)
(blephar/o) eyelid
(nas/o; rhin/o) nose
spinal cord (myel/o)
(or/o; stomat/o) mouth
neck (cervic/o)
(pharyng/o) throat
(esophag/o) esophagus
thyroid gland (thyroid/o)
joint (arthr/o)
(trache/o) windpipe; trachea
(pneum/o; pneumon/o) lung bone (oste/o)
(thorac/o) chest rib cross section (cost/o)

(card/io) heart armpit (axill/o)
(my/o; muscul/o) muscle
(cholecyst/o) gallbladder spleen (splen/o)
(phren/o) diaphragm stomach (gastr/o)

(hepat/o) liver pancreas (pancreat/o)
(col/o) large intestine fat (adip/o; lip/o; steat/o)
(enter/o) small intestine
(appendic/o) vermiform appendix

rectum (rect/o; proct/o)
urinary bladder (cyst/o)

(derm/o; dermat/o) skin
FIGURE 6-3 The prefixes, suffixes, and word roots for parts of the human body.
130 CHAPTER 6
Word Part Meaning Medical Term Meaning
A
a-, an- without, lack of a/pnea without or lack of breathing
ab- from, away ab/duct to move away from the body
-ac, -ic pertaining to cardi/ac pertaining to the heart
acr- (o) extremities (arms and legs) acro/cyan/osis condition of blueness of the extremities
ad- to, toward, near ad/duct to move toward the body
aden- (o) gland, glandular adeno/cele a tumor of a gland
adren- (o) adrenal gland adreno/pathy disease of the adrenal gland
aer- (o) air aero/cele a cavity or pouch swollen with gas or air
-al like, similar, pertaining to neur/al pertaining to a nerve
alba-, albi- white albi/no an organism deficient in pigment, white
alges- (i, ia) pain algesi/meter instrument for measuring pain
-algia pain my/algia muscle pain
ambi- both, both sides ambi/lateral both sides
an- (o, us) anus (opening to rectum) ano/scope an instrument for examining the anus and
rectum
angi- (o) vessel angio/pathy disease of blood vessels
ankyl- crooked, looped, immovable, fixed ankyl/osis stiffness or fixation of a joint
ante- (ro) before, in front of, ahead of ante/partum before labor or childbirth
anti- against anti/bacterial against bacteria
append- (i, o) appendix append/ectomy surgical removal of the appendix
arter- (io) artery aterio/gram tracing or picture of the arteries
arthr- (o) joint arthr/itis inflammation of a joint
-ase enzyme peptid/ase an enzyme that aids in the digestion of
proteins
-asis condition of chole/lithi/asis condition of stones in the gallbladder
-asthenia weakness, lack of strength my/asthenia weakness in a muscle
ather- (o) fatty, lipid athero/sclerosis a fatty hardening
audi- (o) sound, hearing audio/meter an instrument to measure sound or hearing
aur- ear aur/al pertaining to the ear
auto- self auto/phobia a fear of being by oneself or alone
B
bi- (s) twice, double, both bi/lateral two sides
bio- life bio/logy study of science of life
-blast germ/embryonic cell hemo/cyto/blast an embryonic or stem cell for blood cells
blephar- (o) eyelid blepharo/plasty plastic surgery on an eyelid
brachi- arm brachi/algia arm pain
brachy- short brachy/dactyl/ic condition of having short fingers
brady- slow brady/cardia slow heart
bronch- (i, o) air tubes in lungs bronch/itis inflammation of the air tubes in the lungs
bucc- (a, o) cheek bucco/lingu/al pertaining to the cheek and tongue
C
calc- (u, ulus) stone calcul/osis condition of having a stone
carcin- (o) cancer, malignancy carcin/oma cancerous tumor
cardi- (a, o) pertaining to heart cardi/ologist physician who studies and treats heart
disease
carp- (o) wrist carp/itis inflammation of the wrist

-cele, -coele swelling, tumor, cavity, hernia meningo/cele swelling or tumor of the membranes of the
brain and spinal cord
cent- (i) one hundred centi/meter hundred part of a meter (unit of
measurement)
-centesis surgical puncture to remove fluid thora/centesis surgical puncture to remove fluid from the
chest
cephal- (o) head, pertaining to head cephal/algia pain in the head, headache
cerebro- brain cerebro/spin/al pertaining to the brain and spinal cord
cerv- (ic, io) neck, neck of uterus cervio/facial relating to the neck and face
cheil- (o) lip cheilo/plasty plastic surgery to repair lip defects
chem- (o) drug, chemical chemo/therapy treatment with drugs or chemicals
chlor- (o) green chlor/opsia a visual defect in which all objects appear
green
chol- (e, o) bile, gallbladder chole/cyst/ic pertaining to the gallbladder or bag
chond- (i, r, ri) cartilage chondr/itis inflammation of cartilage
chrom- (a, at, o) color chromato/meter an instrument for measuring color
perception
-cide causing death germi/cide causing death to germs
circum- around, about circum/duction movement in a circular motion
-cise cut ex/cise cut out
co- (n) with, together co/chromato/graphy identifying a substance by comparing color
hues with a known substance
-coccus round strepto/coccus round germ causing strep infection
col- (in, o) colon, bowel, large intestine col/ostomy creating an opening into the colon or large
intestine
colp- (i, o) vagina colp/orrhaphy surgical repair of the vaginal wall
contra- against, counter contra/stimulant against a stimulant
cost- (a, i, o) rib cost/ectomy surgical removal of a rib
crani- (o) pertaining to the skull crani/otomy cutting into the skull
-crine secrete exo/crine secrete outside of
cryo- cold cryo/therapy treatment with cold
crypt- (o) hidden, obscure crypto/genic obscure or unknown origin
cut- (an) skin cutane/ous pertaining to the skin
cyan- (o) blue cyan/osis condition of blueness
cyst- (i, o) bladder, bag, sac cyst/itis inflammation of the bladder
cyt- (e, o) cell cyt/ology study of cells
D
dacry- (o) tear duct, tear dacryo/cyst/itis inflammation of the lacrimal (tear duct) sac
dactyl- (o) finger, toe dactyl/oscopy the scientific study of fingerprints
dec- (a, i) ten deci/meter tenth part of a meter (unit of
measurement)
dent- (i, o) tooth dent/al pertaining to teeth
derm- (a, at, o) pertaining to skin dermat/itis inflammation of the skin
-desis surgical union or fixation arthro/desis surgical immobilization of a joint to allow
the bones to grow together
dextr- (i, o) to the right dextro/ocular right eye
di- (plo) double, twice diplo/coccus two round circles
dia- through, between, part dia/dermal cutting through the skin
dis- (ti, to) separation, away from dis/infect to separate or free from infection
dors- (i, o) to the back, back dors/al pertaining to the back
132 CHAPTER 6

duoden- (o) duodenum duoden/ectomy surgical removal of all or part of the
duodenum
dys- difficult, painful, bad dys/uria difficult or painful urination
E
e- (c) without e/dentu/lous condition of being without teeth
ec- (ti, to) outside, external ecto/genous capable of developing away from the host
-ectasis expansion, dilation, stretching bronchi/ectasis dilation or expansion of air tubes in lungs
-ectomy surgical removal of tonsil/ectomy surgical removal of the tonsils
electr- (o) electrical electro/cardio/gram recording of electrical activity in the heart
-emesis vomit hemat/emesis vomiting blood
-emia blood glyc/emia sugar in the blood
encephal- (o) brain encephal/itis inflammation of the brain
endo- within, innermost endo/crine secrete within
enter- (i, o) intestine enter/itis inflammation of the intestine
epi- upon, over, upper epi/gastric above the stomach
erythro- red erythro/cyte red (blood) cell
-esis condition of par/esis condition of paralysis
-esthesia sensation, perception, feel an/esthesia without feeling
eu- well, easy, normal eu/pnea normal respiration or breathing
ex- (o) outside of, beyond exo/path/ic disease that originates outside the body
F
faci- face facio/plegia paralysis of the face
-fascia (l) fibrous band myo/fascial muscle fiber
fibr- (a, i, o) fiber, connective tissue fibr/oma tumor of fibrous tissue
fore- in front of fore/arm the front part of the arm
-form having the form of, shape uni/form one shape or form
-fuge driving away, expelling centri/fuge driving away from the center
G
galacto- milk, galactose (milk sugar) galact/orrhea flow of milk
gast- (i, ro) stomach gastr/itis inflammation of the stomach
-genesis development, production, creation fibro/genesis the development of fibrous tissue
-genetic, -genic origin, producing, causing cyto/genic origin of cells
genito- organs of reproduction genito/urinary organs of reproductive and urinary
systems
-genous kind, type exo/genous outside kind or type
geront- (o) old age, elderly geront/ology study of the elderly
gingiv- gums, gingiva gingiv/itis inflammation of the gums
gloss- (o) tongue glosso/graph instrument for recording movements of the
tongue
gluc- (o) sweetness, sugar, glucose gluco/lipid sugar fat
gly- (c, co) sugar glyc/emia sugar in the blood
-gram tracing, picture, record electro/cardio/gram tracing of the electrical activity in the
heart
-graph diagram, instrument for recording electro/cardio/graph instrument for recording electrical activity
in the heart
gyn- (ec, o) woman, female gynec/ology the study of women
H
hem- (a, ato, o) blood hemat/ology study of the blood
hemi- half hemi/plegia paralysis on half of the body
hepat- (o) liver hepat/itis inflammation of the liver
herni- rupture hernio/plasty surgical repair of a rupture
hetero- other, unlike, different hetero/genous different kind or type
hist- (o) tissue hist/ologist person who studies tissue
hom- (eo, o) same, like homeo/stasis maintaining a constant level
hydro- water hydro/therapy water treatment
hyper- excessive, high, over, increased, hyper/tension high blood pressure
more than normal
hypno- sleep hypno/sis process of sleep
hypo- decreased, deficient, low, under, hypo/tension low blood pressure
less than normal
hyster- (o) uterus hyster/ectomy surgical removal of the uterus
I
-ia, -iasis condition of, abnormal/ pneumon/ia abnormal condition of the lung
pathological state
-ic, -ac pertaining to thorac/ic pertaining to the chest
idio- peculiar to an individual, idio/pathic disease arising by itself or from an
self-originating unknown cause
ile- (o, um) ileum ileo/stomy creating an artificial opening into the ileum
infra- beneath, below infra/sonic sound waves below the frequency of the
human ear
inter- between, among inter/costal between the ribs
intra- within, into, inside intra/ven/ous into a vein
-ism condition, theory, state of being albin/ism condition of being white
iso- equal, alike, same iso/chromatic constant or same color
-itis inflammation, inflammation of pharyng/itis inflammation of the throat
K
kerat- (o) cornea of eye kerato/meter instrument to measure the curvature of the
cornea
-kinesis, -kinetic motion dys/kinetic difficult movement
L
labi- (a, o) lip labio/lingual pertaining to the lips and tongue
lacrima- tears lacrima/tion secretion of tears
lact- (o) milk lacto/genesis production of milk
lapar- (o) abdomen, abdominal wall lapar/otomy cutting into the abdomen
laryng- (o) larynx (voicebox) laryng/itis inflammation of the voicebox
latero- (al) side ambi/lateral both sides
-lepsy seizure, convulsion narco/lepsy sleep seizure
leuco-, leuko- white leuko/cyte white (blood) cell
lingu- (a, o) tongue lingu/al pertaining to the tongue
lip- (o) fat, lipids lipo/cyte fat cell
lith- (o) stone, calculus litho/tripsy crushing a stone
-logy study of, science of bio/logy study or science of life
134 CHAPTER 6

lymph- (o) lymph tissue lymph/oma tumor of lymph tissue
-lys (is, o) destruction, dissolving of thrombo/lysis destruction or dissolving of clots
M
macro- large macro/cyte large cell
mal- bad, abnormal, disordered, poor mal/nutrition poor nutrition
malac- (ia) softening of a tissue malac/ia tissue softening
mamm- (o) breast, mammary glands mammo/gram radiographic (X-ray) image of the breast
-mania insanity, mental disorder pyro/mania individual with the insane desire to start
fires
mast- (o) breast masto/pathy disorder of the breast
med- (i, io) middle, midline medio/carpal in the middle of or between the two rows of
carpals (wrist bones)
-megaly, mega- large, enlarged cardio/megaly enlarged heart
melan- (o) black melan/oma black cancer
mening- (o) membranes covering the brain mening/itis inflammation of the membranes of the
and spinal cord brain and spinal cord
meno- monthly, menstruation meno/rrhea monthly flow or discharge
mes- (o) middle, midline meso/cephal/ic condition of having a head of medium
proportions
-meter measuring instrument, measure urino/meter instrument to measure (specific gravity of)
urine
-metry measurement audio/metry measurement of hearing acuity
micro- small micro/scope instrument to examine small things
mono- one, single mono/cyte single cell
-mortem death post/mortem after death
muc- (o, us) mucus, secretion of mucous muco/static stopping the secretion of mucus
membrane
multi- many, much, a large amount multi/para woman who has borne more than one child
my- (o) muscle my/algia muscle pain
myc- (o) fungus myco/cide substance that kills fungus
myel- (o) bone marrow, spinal cord myelo/blast bone marrow cell
myring- (o) eardrum, tympanic membrane myring/otomy cutting into the eardrum
N
narc- (o) sleep, numb, stupor narco/lepsy sleep seizure
nas- (o) nose nas/al pertaining to the nose
-natal birth pre/natal before birth
necr- (o) death necr/osis condition or process of death
neo- new neo/natal newborn (infant)
neph- (r, ro) kidney nephro/lith kidney stone
neur- (o) nerve, nervous system neur/algia nerve pain
noct- (i) night, at night noct/uria urination at night
non- no, none non/toxic not poison
O
ocul- (o) eye oculo/graph machine to measure eye (movement)
odont- (o) tooth odont/algia pain in a tooth, toothache
olig- (o) few, less than normal, small olig/uria less than normal (amounts of) urine
-ologist person who does/studies radi/ologist person who studies radiographs

-ology study of, science of hemat/ology study of blood
-oma tumor, a swelling carcin/oma cancerous tumor
onco- (i) mass, bulk, tumor oncol/ogist physician who studies cancer
oophor- (o) ovary, female egg cell oophor/ectomy surgical removal of the ovaries
ophthalm- (o) eye ophthalmo/scope instrument for examining the eye
-opia vision dipl/opia double vision
-opsy to view aut/opsy view internal organs of a dead person
opt- (ic) vision, eye optic/al pertaining to the eye
or- (o) mouth or/al pertaining to the mouth
orch- (ido) testicle, testes orch/itis inflammation of a testis
-orrhea flow, discharge rhin/orrhea flow or discharge from the nose
orth- (o) normal, straight ortho/dontics branch of dentistry involved with aligning
or straightening the teeth
ost- (e, eo) bone osteo/genesis formation of bone
-oscopy diagnostic examination colon/oscopy diagnostic examination of the colon or
large intestine
-osis condition, state, process necr/osis condition or process of death
ot- (o) ear oto/scope instrument for examining the ear
-otic pertaining to a condition leuko/cyt/otic condition of white blood cells
-otomy cutting into crani/otomy cutting into the skull
-ous full of, containing, pertaining to, ven/ous pertaining to a vein
condition
ovi-, ovario- egg, female sex gland, ovary ovari/ectomy surgical removal of an ovary
P
pan- all, complete, entire pan/ater/itis inflammation of all layers of an artery
pancreat- (o) pancreas pancreat/itis inflammation of the pancreas
para- near, beside, beyond, abnormal, para/plegia paralysis of the lower half of the body
lower half of the body
-paresis paralysis hemi/paresis paralysis on one side of the body
-partum birth, labor post/partum after birth
path- (ia, o, y) disease, abnormal condition path/ology study of disease
ped- (ia) child pedia/tric pertaining to children
-penia lack of, abnormal reduction in erythro/cyto/penia deficiency of red blood cells
number, deficiency
pent- (a) five penta/dactyl having five digits (fingers or toes)
-pepsia, -pepsis digestion dys/pepsia difficult digestion (indigestion)
per- through, by, excessive per/axillary through the axilla or armpit
peri- around peri/cardi/al pertaining to area around the heart
-pexy fixation gastro/pexy surgical operation in which the stomach is
sutured or fixed to the abdominal wall
phag- (o) eat, ingest phago/cyt/osis process of cells engulfing and destroying
microorganisms
-phage, -phagia to eat, consuming, swallow dys/phagia difficult or painful swallowing
pharyng- (o) pharynx, throat pharyng/itis inflammation of the throat or pharynx
-phas, -phasia speech a/phasia without speech
-philia, -philic affinity for, attracted to necro/philia attracted to or unusual interest in death
phleb- (o) vein phleb/otomy cutting into a vein
-phobia fear hydro/phobia fear of water
phon- (o) sound, voice phon/asthenia weakness or hoarseness of the voice
-phylaxis protection, prevention pro/phylaxis for prevention
136 CHAPTER 6

-plasty surgical correction or repair chondro/plasty surgical repair of cartilage
-plegia paralysis hemi/plegia paralysis of half of the body
pleuro- side, rib pleur/itis inflammation of the pleural membranes
lining the side of the thorax
-pnea breathing a/pnea without breathing
pneum- (o, on) lung, pertaining to the lungs, air pneumon/ectomy surgical removal of a lung (or part of a
lung)
pod- (e, o) foot pod/algia foot pain
poly- many, much poly/uria much urine (more than normal amounts)
post- after, behind post/operative after an operation
pre- before, in front of pre/operative before an operation
pro- in front of, forward pro/cephalic in front of the head
proct- (o) rectum, rectal, anus procto/scope instrument for examining the rectum
pseudo- false pseudo/appendic/itis false inflammation of the appendix
psych- (i, o) pertaining to the mind psych/ology study of the mind
-ptosis drooping down, sagging, visero/ptosis drooping down or displacement of internal
downward displacement organs
pulmon- (o) lung pulmon/ary pertaining to the lung
py- (o) pus pyo/genic producing pus
pyel- (o) renal pelvis of kidney pyelo/lith/otomy surgical incision of the renal pelvis to
remove a stone
pyr- (o) heat, fever pyro/genic produced by a fever
Q
quad- (ra, ri) four quadra/plegia paralysis of four extremities (arms and
legs)
R
radi- (o) radiographs (X-rays), radiation radi/ologist person who studies radiographs
rect- (o) rectum recto/cele rupture of the rectum
ren- (o) kidney ren/al pertaining to the kidney
retro- backward, in back, behind retro/lingual occurring behind or near the base of the
tongue
rhin- (o) nose, pertaining to the nose rhino/plasty surgical correction of the nose
-rraphy suture of, sewing up of a gap angio/rraphy sewing (suturing) a gap or defect in a
or defect vessel
-rrhagia sudden or excessive flow rhino/rrhagia sudden flow from the nose (nosebleed)
-rrhea flow, discharge meno/rrhea monthly flow or discharge
-rrhexis rupture of, bursting hystero/rrhexis rupture of the uterus
S
salping- (i, o) tube, fallopian tube salping/ectomy surgical removal of a fallopian tube
sanguin- (o) blood sanguino/purulant containing blood and pus
sarc- (o) malignant (cancer) connective tissue sarc/oma cancerous tumor of connective tissue
-sarcoma tumor, cancer adeno/sarcoma cancerous tumor of a gland
scler- (o) hardening sclero/derma thickening or hardening of the skin
-sclerosis dryness or hardness arterio/sclerosis hardness of an artery
-scope examining instrument oto/scope instrument for examining the ear
-scopy observation procto/scopy examination of the rectum
-sect cut bi/sect to cut into two parts
semi- half, part semi/cartilagin/ous partly of cartilage

sep- (ti, tic) poison, rot, infection septic/emia blood infection
sinistr- (o) left sinistr/ocular left eye
soma- (t, to) body somato/genic originating in the body
son- (o) sound sono/gram an image produced by sound waves
-spasm involuntary contraction myo/spasm contraction of muscle
sperm- (ato) spermatozoa, male germ (sex) cell spermat/uria discharge of sperm in the urine
splen- (o) spleen spleno/megaly abnormal enlargement of the spleen
-stasis stoppage, maintaining a homeo/stasis maintaining the same constant level
constant level
steno- contracted, narrow steno/sis condition of narrowing
stern- (o) sternum, breast bone sterno/cost/al pertaining to the ribs and breastbone
(sternum)
stoma- (t) mouth stomat/ology scientific study of the mouth and its
disorders
-stomy artificial opening colo/stomy creating an opening into the colon or large
intestines
sub- less, under, below sub/lingual under the tongue
sup- (er, ra) above, upon, over, higher supra/thorac/ic pertaining to the area in the upper part of
in position the chest
sym-, syn- joined, fused, together syn/dactyl two or more digits (fingers or toes) joined
together
T
tach- (o, y) rapid, fast tachy/cardia fast or rapid heart
ten- (do, don, o) tendon tendon/itis inflammation of a tendon
tetra- four tetra/paresis weakness or paralysis of all four limbs
-therapy treatment chemo/therapy treatment with drugs or chemicals
therm- (o, y) heat therm/algesia sensitive to heat
thorac- (o) thorax, chest thorac/otomy cutting into the chest
thromb- (o) clot, thrombus thrombo/lysis dissolving or destruction of clots
thym- (o) thymus gland thym/oma tumor of the thymus gland
thyr- (o, oid) thyroid gland thyroid/ologist individual who studies the thyroid gland
-tome instrument that cuts myo/tome instrument for cutting muscle
-tox (ic) poison cyto/toxic cell poison
trach- (e, i, o) trachea, windpipe trache/otomy cutting into the trachea or windpipe
trans- across, over, beyond trans/neural across a nerve
tri- three tri/angle three angles
trich- (o) hair tricho/myo/sis fungus disease of the hair
-trips (y) crushing by rubbing or grinding litho/tripsy crushing of stone
-trophy nutrition, growth, development a/trophy without nutrition (wasting away)
tympan- (o) eardrum, tympanic membrane tympan/itis inflammation of the eardrum (tympanic
membrane)
U
ultra- beyond, excess ultra/sonic beyond sound waves
uni- one uni/ocular one eye
ur- (in, o) urine, urinary tract urino/meter instrument to measure (specific gravity)
urine
ureter- (o) ureter (tube from kidney to bladder) uretero/cele dilation of the ureter into the bladder
138 CHAPTER 6

urethr- (o) urethra (tube from bladder urethro/scope instrument to view the urethra
to urinary meatus)
-uria urine hemat/uria blood in urine
uter- (o) uterus, womb utero/vaginal pertaining to the uterus and vagina
V
vas- (o) vessel, duct vaso/neur/otic pertaining to blood vessels and nerves
ven- (a) vein ven/ous pertaining to vein
ventro- to the front, abdomen ventr/al pertaining to the front
vertebr- (o) spine, vertebrae vertebr/al pertaining to the spine or vertebrae
vesic- (o) urinary bladder vesico/urethral connecting the urinary bladder and urethra
viscer- (o) internal organs viscero/ptosis drooping or displacement of internal
organs
vit- (a) necessary for life vit/al important to life
X
xanth- (o) yellow xantho/derma yellowish discoloration of the skin
-xen (ia, a) strange, abnormal xeno/genetic derived or originating from a foreign
species
Z
zoo- animal zoo/ology study of animals
zymo- enzymes zymo/gram picture or tracing of enzymes

Artificial red blood cells that replace the need for blood transfusions?
Blood is needed for life. Erythrocytes (red blood cells) in the blood carry the oxygen that
is needed by all body cells. The erythrocytes also carry carbon dioxide, a waste product of
the cells, to the lungs so it can be expelled from the body. Without oxygen, body cells will die
in 4 to 6 minutes.
When a person has a hemorrhage and loses a large amount of blood, an immediate
blood transfusion is needed. The blood for the transfusion comes from other individuals
who are willing to donate blood. However, the annual worldwide shortage of blood is esti-
mated to be about 100 million units. Scientists are busy researching the development of
“artificial” blood or some type of blood cell that will carry the oxygen needed by the body.
Already several products have been developed that meet this need. Dr. Thomas Chang is
one researcher who has worked on this problem since the 1960s. He invented microencap-
sulation, a technique that allows a biochemical to be held inside an artificial membrane. His
work has led to the development of a modified hemoglobin called polyhemoglobin. This
substance carries oxygen in the same way hemoglobin on red blood cells carries oxygen.
Clinical trials of the product are currently being conducted. Another product that has been
developed by Alliance Pharmaceutical is Oxygent. Oxygent is a sterile perfluorochemical
solution that can be used with all blood types, has a shelf life of about 2 years, and contains
no human or animal blood. It carries oxygen in the bloodstream and is used in place of a
blood transfusion. Studies on Oxygent are currently being conducted in Europe. There is
little doubt that researchers will eventually find a substitute for blood transfusions.
STUDENT: Go to the workbook and complete cause of the disease, signs and symptoms, and
the assignment and evaluation sheets for 6:2, main forms of treatment.
Interpreting Word Parts. 3. Cancer: combine word parts to create words
ending in oma. Then search for information on
the different types of tumors. Research benign
CHAPTER 6 SUMMARY and malignant tumors and the signs and
symptoms for each. (Hint: locate the Web site
for the American Cancer Society.)
Medical abbreviations and terminology are used
in all health care occupations and facilities. To
communicate effectively, health care workers REVIEW QUESTIONS
must be familiar with common abbreviations
and terminology. 1. Determine the meaning of the abbreviations
Medical abbreviations are shortened forms bid, tid, and qid. Find prefixes that define the
of words, usually just letters. Sometimes, they first letters (b, t, and q) of the three abbrevia-
are used by themselves; other times, several ab- tions. Determining associations similar to
breviations are combined to give orders or di- these will make it easier to learn medical
rections. abbreviations.
Medical terminology consists of the use of
prefixes, suffixes, and word roots to create words. 2. List ten (10) abbreviations for diseases or
Entire dictionaries have been written to include disorders of the body.
the terminology used in health care. It would be 3. List ten (10) abbreviations for diagnostic tests
impossible to memorize the meaning of every such as blood work or radiology (X-ray)
word. By learning common prefixes, suffixes, studies.
and word roots, however, a health care worker
can break a word into parts and figure out the 4. Add the suffix -oma to five different word roots
meaning of the word. for tissues or parts of the body. Check a medi-
cal dictionary to determine whether the
spelling is correct and to learn the full meaning
INTERNET SEARCHES of the word. One example is melanoma.
5. Choose five (5) word roots related to a part of
Use the suggested search engines in Chapter 12:4 the body. Add different prefixes and/or suffixes
of this textbook to search the Internet for addi- to the word root to create at least three differ-
tional information on the following topics: ent terms for each body part. For example:
1. Medical terminology resources: search publish- cystitis, cystoscopy, and cystocele.
ers such as Delmar Cengage Learning, Mosby, 6. A patient is admitted to a hospital with a dx of
or McGraw-Hill, for medical terminology pancreatitis, dysphagia, and gastralgia. Sx
books, videos, and software. Evaluate different include NVD and a severe HA. The dr orders an
methods of learning medical terminology as abd MRI, CBC, NPO except for cl liq, VS q2h,
presented in these resources. and CBR. Interpret all the above medical
2. Diseases: combine word parts to name diseases abbreviations and terms to determine the
or conditions such as cholecystitis. Search for patient’s condition and plan of treatment.
information on the diseases. Research the
CHAPTER 7 Anatomy and
Physiology
Chapter Objectives
Observe Standard
Precautions
◆ Apply the appropriate terminology to major
organs and systems of the human body
◆ Identify the major functions of each body
system
◆ Compare interrelationships of body systems
Safety—Proceed with ◆ Describe basic diseases affecting each of the
Caution body systems
OBRA Requirement—Based NOTE: This chapter is meant to serve as a brief introduction to
on Federal Law anatomy and physiology. For more detailed information, refer to
the references listed in the bibliography at the back of the book.
Math Skill
Science Skill
Career Information
Technology
Anatomy and Physiology 141
KEY TERMS
anatomy genes organ
cell genome organelles
cell membrane Golgi apparatus pathophysiology
centrosome (sen!-troh-sohm) (gawl!-jee ap-a-rat!-us) physiology
chromatin (crow!-ma-tin) lysosomes (ly!-sah-soms) (fizz-ee-all!-oh-gee)
connective tissue meiosis (my-o!-sis) pinocytic vesicles
cytoplasm (sy!-toe-plaz-um) mitochondria protoplasm
dehydration (my-toe-con!-dree-ah) (pro!-toe-plaz-um)
edema (eh-dee!-mah) mitosis (my-toe!-sis) stem cells
endoplasmic reticulum muscle tissue system
(en!-doe-plaz-mik re-tik!- nerve tissue tissue
you-lum) nucleolus (new"-klee-oh!-lus) vacuoles
epithelial tissue nucleus
(ep!-eh-thiel"-e-al tish!-u)
♦ Compare the four main types of tissue by

7:1 Basic Structure describing the basic function of each type
of the Human Body ♦ Explain the relationships among cells, tissues,
organs, and systems
Objectives
♦ Define, pronounce, and spell all key terms
After completing this section, you should be able
to:
7:1 INFORMATION
♦ Label a diagram of the main parts of a cell
The human body is often described as an effi-
♦ Describe the basic function of each part of a cient, organized machine. When this machine
cell does not function correctly, disease occurs. Before

NOTE: A basic knowledge of human anatomy and physiology is essential for almost every
health care provider. However, some health careers are related to specific body systems. As
each body system is discussed, examples of related health careers are listed. The following
health career categories require knowledge of the structure and function of the entire human
body and will not be listed in specific body system units.
◆ Athletic Trainer ◆ Medical Assistant ◆ Physician Assistant

◆ Emergency Medical ◆ Medical Illustrator ◆ Physician
Careers ◆ Nursing Careers ◆ Surgical Technologist
◆ Medical Laboratory
◆ Pharmacy Careers
Careers
142 CHAPTER 7
understanding the disease processes, however, brane that contains pores to allow substances
the health worker must first understand the nor- to pass between the nucleus and cytoplasm. It
mal functioning of the body. A basic understand- is often called the “brain” of the cell because it
ing of anatomy and physiology is therefore controls many cell activities and is important
necessary. Anatomy is the study of the form and in the process of mitosis or cell division.
structure of an organism. Physiology is the ♦ Nucleolus: one or more small, round bodies
study of the processes of living organisms, or why located inside the nucleus, and important in
and how they work. Pathophysiology is the cell reproduction. Ribosomes, made of ribo-
study of how disease occurs and the responses of nucleic acid (RNA) and protein, are manufac-
living organisms to disease processes. tured in the nucleolus. The ribosomes move
The basic substance of all life is protoplasm. from the nucleus to the cytoplasm, where they
This material makes up all living things. Although aid in the synthesis (production) of protein.
protoplasm is composed of ordinary elements They can exist freely in the cytoplasm or be
such as carbon, oxygen, hydrogen, sulfur, nitro- attached to the endoplasmic reticulum.
gen, and phosphorus, scientists are unable to
♦ Chromatin: located in the nucleus and made
combine such elements to create that character-
of deoxyribonucleic acid (DNA) and protein.
istic called life.
During cell reproduction, the chromatin con-
denses to form rodlike structures called chro-
mosomes. A human cell has 46 chromosomes
CELLS or 23 pairs. Each chromosome contains
between 30,000 to 45,000 genes, the struc-
Protoplasm forms the basic unit of structure and
tures that carry inherited characteristics. Each
function in all living things: the cell. Cells are
gene has a specific and unique sequence of
microscopic structures that carry on all the func-
approximately 1,000 base pairs of DNA; the
tions of life. They take in food and oxygen; pro-
DNA sequence carries the genetic coding that
duce heat and energy; move and adapt to their
allows for exact duplication of the cell. Because
environment; eliminate wastes; perform special
the DNA sequence on genes is unique for each
functions; and reproduce to create new, identical
individual, it is sometimes used as an identifi-
cells. The human body contains trillions of cells.
cation tool similar to fingerprints, but much
These cells vary in shape and size, and perform
more exact. A genome is the total mass of
many different functions.
genetic instruction humans inherit from their
Most cells have the following basic parts (fig-
parents. It consists of strings of DNA nucleo-
ure 7-1):
tides. Human beings have about three billion
♦ Cell membrane: the outer protective cover- nucleotides in their genome. The order of the
ing of the cell. It is also called the plasma nucleotides on the DNA sequences provides
membrane or plasmalemma. It is semiperme- instructions for the body to build all of its
able; that is, it allows certain substances to parts, everything from permanent structures
enter and leave the cell while preventing the such as teeth and brain cells to short-lived
passage of other substances. substances such as blood and hormones.
♦ Cytoplasm: a semifluid inside the cell but out- ♦ Centrosome: located in the cytoplasm and
side the nucleus. It contains water (70–90 per- near the nucleus. It contains two centrioles.
cent), proteins, lipids (fats), carbohydrates, During mitosis, or cell division, the centrioles
minerals, and salts. It is the site for all chemical separate. Thin cytoplasmic spindle fibers form
reactions that take place in the cell, such as pro- between the centrioles and attach to the chro-
tein synthesis (formation) and cellular respira- mosomes. This creates an even division of the
tion. Organelles, or cell structures that help a chromosomes in the two new cells.
cell to function, are located in the cytoplasm. ♦ Mitochondria: rod-shaped organelles lo-
The main organelles are the nucleus, mitochon- cated throughout the cytoplasm. These are
dria, ribosomes, lysosomes, centrioles, Golgi often called the “furnaces” or “powerhouses”
apparatus, and endoplasmic reticulum. of the cell because they break down carbohy-
♦ Nucleus: a mass in the cytoplasm. It is sepa- drates, proteins, and fats to produce adeno-
rated from the cytoplasm by a nuclear mem- sine triphosphate (ATP), the major energy
Nucleolus
Smooth endoplasmic
reticulum
Mitochondrion
Nucleus
Cell membrane
Pinocytic vessel
Vacuole
Cytoplasm
Ribosomes
Lysosome
Centrioles
Golgi apparatus Chromatin Rough endoplasmic reticulum

FIGURE 7-1 Basic parts of a cell.
source of the cell. A cell can contain just 1 to endoplasmic reticulum contains ribosomes,
more than 1,000 mitochondria, depending on which are the sites for protein synthesis (pro-
how much energy the cell requires. duction). Smooth endoplasmic reticulum
♦ Golgi apparatus: a stack of membrane lay- does not contain ribosomes and is not present
ers located in the cytoplasm. This structure in all cells. It assists with cholesterol synthesis,
produces, stores, and packages secretions for fat metabolism, and detoxification of drugs.
discharge from the cell. Cells of the salivary, ♦ Vacuoles: pouchlike structures found
gastric, and pancreatic glands have large num- throughout the cytoplasm that have a vacuo-
bers of Golgi apparatus. lar membrane with the same structure as the
♦ Endoplasmic reticulum: a fine network of cell membrane. They are filled with a watery
tubular structures located in the cytoplasm. substance, stored food, or waste products.
This network allows for the transport of mate- ♦ Lysosomes: oval or round bodies found
rials into and out of the nucleus, and also aids throughout the cytoplasm. These structures
in the synthesis and storage of proteins. Rough contain digestive enzymes that digest and
144 CHAPTER 7
destroy old cells, bacteria, and foreign materi- Centrosome

Nucleolus
als, an important function of the body’s DNA in nucleus
immune system. Lysosomes also fuse with 1
stored food vacuoles to convert the food to a
form that can be used by the mitochondria to 4
produce ATP (energy).
♦ Pinocytic vesicles: pocketlike folds in the
cell membrane. These folds allow large mole-
cules such as proteins and fats to enter the
cell. When such molecules are inside the cell, DNA molecules
duplicate themselves.
the folds close to form vacuoles or bubbles in
the cytoplasm. When the cell needs energy,
the vesicles fuse with lysosomes to allow the
proteins and fats to be digested and used by Aster
2
the mitochondria to produce ATP (energy). Spindle Chromosomes
Centromere separate.
Centriole
Cell Reproduction Chromatids
Most cells reproduce by dividing into two identical

cells. This process is called mitosis, a form of
asexual reproduction (figure 7-2). Skin cells, blood- 5
forming cells, and intestinal tract cells reproduce
continuously. Muscle cells only reproduce every
Centrioles separate, and a
few years, but muscle tissue can be enlarged with spindle forms between them.
exercise. Some specialized cells, such as nerve cells
in the brain and spinal cord, do not reproduce
after birth. If these cells are damaged or destroyed,
others are not formed to replace them.
3
Prior to mitosis, the chromatin material in the
nucleus condenses to form chromosomes, and an
exact duplicate of each chromosome is made. Two nuclei form as
cell separates.
Each chromosome then consists of two identical
strands, called chromatids, joined together by a
structure called a centromere. When mitosis begins,
the two centrioles in the centrosome move to
opposite ends of the cell. A spindle of threadlike
6
fibers trails from the centrioles. The nuclear mem-
brane disappears, and the pairs of duplicated Duplicated chromosomes line
chromosomes attach to the spindles at the center up along center of spindle.
of the cell. The chromatids then split from their
duplicated halves and move to opposite ends of
the cell. Each end now has 46 chromosomes, or 23
pairs. The cytoplasm divides, and a new cell mem-
brane forms to create two new identical cells.
Sex cells (gametes) divide by a process known
as meiosis. This process uses two separate cell Each new cell has the full
divisions to produce four new cells. When female number of chromosomes.
cells (ova) or male cells (spermatozoa or sperm)
divide by meiosis, the number of chromosomes
is reduced to 23, or one-half the number found in
cells created by mitosis. When an ovum and FIGURE 7-2 Mitosis is a form of asexual repro-
sperm join to create a new life, the zygote, or new duction where a cell divides into two identical cells.
cell, has 46 chromosomes: 23 from the ovum and called dehydration occurs. When there is an
23 from the sperm. Thus, the zygote has 46, or 23 excess amount (too much tissue fluid), a condi-
pairs, of chromosomes, the normal number for tion called edema, or swelling of the tissues,
all body cells except the sex cells. occurs.
Immediately after the ovum and sperm join There are four main groups of tissues: epithe-
to form a zygote, the zygote begins a period of lial, connective, nerve, and muscle (figure 7-3).
rapid mitotic division. Within 4–5 days, the zygote Epithelial tissue covers the surface of the
is a hollow ball-like mass of cells called a blasto- body and is the main tissue in the skin. It forms
cyst. Within this blastocyst are embryonic stem the lining of the intestinal, respiratory, circula-
cells. These stem cells have the ability to trans- tory, and urinary tracts, as well as that of other
form themselves into any of the body’s special- body cavities. Epithelial tissue also forms the
ized cells and perform many different functions. body glands, where it specializes to produce spe-
A controversial area of research is now concen- cific secretions for the body, such as mucus and
trated on these stem cells. Scientists are attempt- digestive juices.
ing to determine whether stem cells can be Connective tissue is the supporting fabric of
transplanted into the body and used to cure dis- organs and other body parts. There are two main
eases such as diabetes mellitus, Parkinson’s, heart classes of connective tissue: soft and hard. One
disease, osteoporosis, arthritis, and spinal cord
injuries. The hope is that the stem cells can be Structure Function
programmed to produce new specialized cells
that can replace a body’s damaged cells and cure
a disease. The controversy arises from the fact
that a 4–5-day embryo, capable of creating a new Control
life, is used to obtain the cells. Right-to-life advo- and
cates are strongly opposed to stem cell research if communicate
the cells are obtained from embryos. Another
source of stem cells is the blood in the discarded Nerve
umbilical cord and placenta of a newborn. Cur-
rently, parents have the option of preserving this
blood for its stem cells. The blood is collected and
frozen in liquid nitrogen. If the child later devel- Secrete
ops a disease for which a stem cell transplant can and
provide a cure, the cells can be harvested from protect
the blood and used for the transplant. The cost of
this procedure limits its use, however. Stem cells Epithelium
also exist in adult tissues, such as bone marrow
and the liver. Adult stem cells, however, do not
have the ability to evolve into every kind of cell;
these stem cells evolve into more cells of their Move
own kind. This controversy will continue as sci- and
entists expand stem cell research. protect
Muscle (cardiac)
TISSUE
Although most cells contain the same basic parts,
cells vary greatly in shape, size, and special func- Support
and
tion. When cells of the same type join together for connect
a common purpose, they form a tissue. Tissues
are 60–99 percent water with various dissolved
Connective tissue
substances. This water is slightly salty in nature
and is called tissue fluid. If there is an insufficient FIGURE 7-3 Four main groups of tissues and their
amount (not enough tissue fluid), a condition functions.
146 CHAPTER 7
type of soft connective tissue is adipose, or fatty, helps form the rigid structure of the human body.
tissue, which stores fat as a food reserve or source Blood and lymph are classified as liquid connec-
of energy, insulates the body, fills the area between tive tissue, or vascular tissue. Blood carries nutri-
tissue fibers, and acts as padding. A second type of ents and oxygen to the body cells and carries
soft connective tissue is fibrous connective tissue, metabolic waste away from cells. Lymph trans-
such as ligaments and tendons, which help hold ports tissue fluid, proteins, fats, and other materi-
body structures together. Hard connective tissue als from the tissues to the circulatory system.
includes cartilage and bone. Cartilage is a tough, Nerve tissue is made up of special cells
elastic material that is found between the bones of called neurons. It controls and coordinates body
the spine and at the end of long bones. It acts as a activities by transmitting messages throughout
shock absorber and allows for flexibility. It is also the body. The nerves, brain, and spinal cord are
found in the nose, ears, and larynx, or “voice box,” composed of nerve tissue.
to provide form or shaping. Bone is similar to car- Muscle tissue produces power and move-
tilage but has calcium salts, nerves, and blood ves- ment by contraction of muscle fibers. There are
sels; it is frequently called osseous tissue. Bone three main kinds of muscle tissue: skeletal, cardiac,
TABLE 7-1 Systems of the Body

SYSTEM FUNCTIONS MAJOR ORGANS/STRUCTURES
Integumentary Protects body from injury, infection, and dehydration; Skin, sweat and oil glands, nails, and hair
helps regulate body temperature; eliminates some
wastes; produces vitamin D
Skeletal Creates framework of body, protects internal organs, Bones and cartilage
produces blood cells, acts as levers for muscles
Muscular Produces movement, protects internal organs, Skeletal, smooth, and cardiac muscles
produces body heat, maintains posture
Nervous Coordinates and controls body activities Nerves, brain, spinal cord
Special Senses Allow body to react to environment by providing Eye, ear, tongue, nose, general sense
sight, hearing, taste, smell, and balance receptors
Circulatory Carries oxygen and nutrients to body cells; carries Heart, blood vessels, blood, spleen
waste products away from cells; helps produce cells
to fight infection
Lymphatic Carries some tissue fluid and wastes to blood, Lymph nodes, lymph vessels, spleen,
assists with fighting infection tonsils, and thymus gland
Respiratory Breathes in oxygen and eliminates carbon dioxide Nose, pharynx, larynx, trachea, bronchi, lungs
Digestive Digests food physically and chemically, transports Mouth, salivary glands, pharynx, esopha-
food, absorbs nutrients, eliminates waste gus, stomach, intestine, liver, gallbladder,
pancreas
Urinary Filters blood to maintain fluid and electrolyte balance Kidneys, ureters, urinary bladder, urethra
in the body, produces and eliminates urine
Endocrine Produces and secretes hormones to regulate body Pituitary, thyroid, parathyroid, adrenal,
processes and thymus glands; pancreas, ovaries, testes
Reproductive Provides for reproduction Male: testes, epididymis, vas deferens,
ejaculatory duct, seminal vesicles, prostate
gland, penis, urethra
Female: ovaries, fallopian tubes, uterus,
vagina, breasts
and visceral (smooth). Skeletal muscle attaches to in succeeding sections) are the integumentary,
the bones and provides for movement of the body. skeletal, muscular, circulatory, lymphatic, ner-
Cardiac muscle causes the heart to beat. Visceral vous, respiratory, digestive, urinary (or excretory),
muscle is present in the walls of the respiratory, endocrine, and reproductive. Their functions and
digestive, urinary tract, and blood vessels. main organs are shown in table 7-1.
In summary, cells combine to form tissues,
tissues combine to form organs, and organs and
ORGANS AND SYSTEMS other body parts combine to form systems. These
systems working together help create the miracle
Two or more tissues joined together to perform a called the human body (figure 7-4).
specific function are called an organ. Examples
of organs include the heart, stomach, and lungs.
Organs and other body parts joined together STUDENT: Go to the workbook and complete
to perform a particular function are called a sys- the assignment sheet for 7:1, Basic Structure of the
tem. The basic systems (discussed in more detail Human Body.
Organism
Human Organism
Organ Systems
Organism Respiratory System
Nervous System
Digestive System
Circulatory System
Integumentary System
Skeletal System
Muscular System
Lymphatic System
Organ System Urinary System
Endocrine System
Reproductive System
Organs
Lung
Brain
Organ
Stomach
Kidney
Tissues
Epithelial Tissue
Nervous Tissue
Muscle Tissue
Tissue
Connective Tissue
Increasing Cells
Complexity Epithelial Cell
Nerve Cell
Muscle Cell
Cell
Organelles
Mitochondrion
Organelle Nucleus
Ribosome
Molecules
Sugars
Molecule C6H12O6 Proteins
Water
Atoms or Ions
Carbon
Hydrogen FIGURE 7-4 The levels of
Oxygen
Atom or Ion Nitrogen
complexity in the human
of an Element organism.
148 CHAPTER 7
7:2 Body Planes,

Directions, and Cavities
Objectives
♦ Label a diagram of the main body cavities
to: ♦ Identify the main organs located in each body
cavity
♦ Label the names of the planes and the direc-
tional terms related to these planes on a dia- ♦ Locate the nine abdominal regions
gram of the three planes of the body ♦ Define, pronounce, and spell all key terms
KEY TERMS
abdominal cavity dorsal pelvic cavity
abdominal regions dorsal cavity posterior
anterior frontal (coronal) plane proximal (prox!-ih-mahl)
body cavities inferior spinal cavity
body planes lateral (lat!-eh-ral) superior
buccal cavity medial (me!-dee-al) thoracic cavity (tho-rass!-ik)
caudal (kaw!-doll) midsagittal (median) plane transverse plane
cranial (kray!-nee-al) (mid-saj!-ih-tahl) ventral
cranial cavity nasal cavity ventral cavity
distal orbital cavity
half. Body parts above other parts are termed

7:2 INFORMATION superior, and body parts below other parts are
Because terms such as south and east would be termed inferior. For instance, the knee is supe-
difficult to apply to the human body, other direc- rior to the ankle, but inferior to the hip. Two other
tional terms have been developed. These terms directional terms related to this plane include
are used to describe the relationship of one part cranial, which means body parts located near
of the body to another part. The terms are used the head, and caudal, which means body parts
when the body is in anatomic position. This located near the sacral region of the spinal col-
means the body is facing forward, standing erect, umn (also known as the “tail”).
and holding the arms at the sides with the palms The midsagittal or median plane divides
of the hands facing forward. the body into right and left sides. Body parts close
to the midline, or plane, are called medial, and
body parts away from the midline are called lat-
BODY PLANES eral.
The frontal or coronal plane divides the
Body planes are imaginary lines drawn through body into a front section and a back section.
the body at various parts to separate the body Body parts in front of the plane, or on the front of
into sections. Directional terms are created by the body, are called ventral or anterior. Body
these planes. The three main body planes are the parts on the back of the body are called dorsal or
transverse, midsagittal, and frontal (figure 7-5). posterior.
The transverse plane is a horizontal plane Two other directional terms are proximal
that divides the body into a top half and a bottom and distal. These are used to describe the loca-
Midsagittal plane The ventral cavities are larger than the dor-
Right Left Midline sal cavities. The ventral cavity is separated into
two distinct cavities by the dome-shaped muscle
Lateral (away
from midline) called the diaphragm, which is important for res-
piration (breathing). The thoracic cavity is
Medial (toward
the midline) located in the chest and contains the esophagus,
trachea, bronchi, lungs, heart, and large blood
Proximal vessels. The abdominal cavity, or abdomino-
(closer to Cranial pelvic cavity, is divided into an upper part and a
point of (toward the
head) lower part. The upper abdominal cavity contains
reference)
the stomach, small intestine, most of the large
Superior (above)
intestine, appendix, liver, gallbladder, pancreas,
Distal
(away and spleen. The lower abdominal cavity, or pel-
Transverse plane
from vic cavity, contains the urinary bladder, the
point of reproductive organs, and the last part of the large
reference) Inferior (below)
intestine. The kidneys and adrenal glands are
Caudal technically located outside the abdominal cavity
(toward the tail) because they are behind the peritoneal mem-
brane (peritoneum) that lines the abdominal
cavity. This area is called the retroperitoneal
Posterior/dorsal/
back space.
Three small cavities are the orbital cavity
Frontal plane for the eyes, the nasal cavity for the nose struc-
tures, and the buccal cavity, or mouth, for the
Anterior/ventral/
front
teeth and tongue.
FIGURE 7-5 Body planes and directional terms.

ABDOMINAL REGIONS
The abdominal cavity is so large that it is divided
tion of the extremities (arms and legs) in relation into regions or sections. One method of division
to the main trunk of the body, generally called the is into quadrants, or four sections. As shown in
point of reference. Body parts close to the point of figure 7-7, this results in a right upper quadrant
reference are called proximal, and body parts (RUQ), left upper quadrant (LUQ), right lower
distant from the point of reference are called dis- quadrant (RLQ), and left lower quadrant (LLQ). A
tal. For example, in describing the relationship of more precise method of division is into nine
the wrist and elbow to the shoulder (or point of abdominal regions (figure 7-8). The center
reference), the wrist is distal and the elbow is regions are the epigastric (above the stomach),
proximal to the shoulder. umbilical (near the umbilicus or belly button),
and hypogastric, or pelvic (below the stomach).
On either side of the center the regions are the
BODY CAVITIES hypochondriac (below the ribs), lumbar (near the
large bones of the spinal cord), and iliac, or ingui-
Body cavities are spaces within the body that nal (near the groin).
contain vital organs. There are two main body The terms relating to body planes, directions,
cavities: the dorsal, or posterior, cavity and the and cavities are used frequently in the study of
ventral, or anterior, cavity (figure 7-6). human anatomy.
The dorsal cavity is one long, continuous
cavity located on the back of the body. It is divided
into two sections: the cranial cavity, which con- STUDENT: Go to the workbook and complete
tains the brain, and the spinal cavity, which the assignment sheet for 7:2, Body Planes, Direc-
contains the spinal cord. tions, and Cavities.
150 CHAPTER 7
Cranial Orbital cavity

cavity
Nasal cavity
Buccal cavity
Thoracic cavity
Dorsal cavity Spinal
(vertebral
canal) Diaphragm
Ventral cavity
Abdominal cavity
Abdomino-
pelvic cavity
Pelvic cavity
FIGURE 7-6 Body cavities.
Right Left
Umbilicus hypo- Epigastric hypo-
chondriac region chondriac
Right upper Left upper region region
quadrant quadrant
(RUQ) (LUQ)
Right Left
lumbar Umbilical lumbar
region region region
Right lower Left lower
quadrant quadrant
(RLQ) (LLQ)
Right Left
iliac Hypogastric iliac
region region region
FIGURE 7-7 Abdominal quadrants. FIGURE 7-8 Nine abdominal regions.
♦ List six functions of the skin

7:3 Integumentary System
♦ Provide the correct names for three abnormal
Objectives colors of the skin and identify the cause of
After completing this section, you should be able each abnormal color
to: ♦ Describe at least four skin eruptions
♦ Label a diagram of a cross section of the skin ♦ Describe at least four diseases of the integu-
♦ Differentiate between the two types of skin mentary system
glands ♦ Define, pronounce, and spell all key terms
KEY TERMS
albino integumentary system subcutaneous fascia
alopecia (in-teg-u-men!-tah-ree) (hypodermis)
constrict (kun-strict!) jaundice (jawn!-diss) (sub-q-tay!-nee-us fash!-
crusts macules (mack!-youlz) ee-ah)
cyanosis (sy!-eh-noh!-sis) melanin sudoriferous glands
papules (pap!-youlz) (sue-de-rif!-eh-rus)
dermis
pustules (pus!-tyoulz) ulcer
dilate (die!-late)
sebaceous glands vesicles (ves!-i-kulz)
epidermis (eh-pih-der!-mis)
(seh-bay!-shus) wheals
erythema (err-ih-thee!-ma)

◆ Allergist ◆ Dermatologist ◆ Plastic Surgeon
7:3 INFORMATION ers are the stratum corneum, the outermost

layer, and the stratum germinativum, the
The integumentary system, or skin, has been innermost layer. The cells of the stratum cor-
called both a membrane, because it covers the neum are constantly shed and replaced by
body, and an organ, because it contains several new cells from the stratum germinativum.
kinds of tissues. Most anatomy courses, however,
♦ Dermis: also called corium, or “true skin.”
refer to it as a system because it has organs and
This layer has a framework of elastic connec-
other parts that work together to perform a par-
tive tissue and contains blood vessels, lymph
ticular function. On an average adult, the skin
vessels, nerves, involuntary muscle, sweat and
covers more than 3,000 square inches of surface
oil glands, and hair follicles. The top of the
area and accounts for about 15 percent of total
dermis is covered with papillae, which fit into
body weight.
ridges on the stratum germinativum of the
Three main layers of tissue make up the skin
epidermis. These ridges form lines, or stria-
(figure 7-9):
tions, on the skin. Because the pattern of
♦ Epidermis: the outermost layer of skin. This ridges is unique to each individual, finger-
layer is actually made of five smaller layers but prints and footprints are often used as meth-
no blood vessels or nerve cells. Two main lay- ods of identification.
152 CHAPTER 7
Sweat pore
Hair shaft
Dermal papilla
Sensory nerve
Stratum ending for touch
corneum
Stratum Epidermis
lucidum
Stratum
Stratum spinosum Dermis
germinativum Stratum
basale
Arrector pili muscle
Sebaceous (oil) gland
Subcutaneous
Hair follicle fatty tissue
(hypodermis)
Papilla of hair
Nerve fiber Vein
Artery
Nerve
Sweat gland
Pacinian corpuscle
FIGURE 7-9 Cross-section of skin.
♦ Subcutaneous fascia or hypodermis: the (which grows in a hollow tube called a follicle)
innermost layer. It is made of elastic and and a hair shaft. Hair helps protect the body and
fibrous connective tissue and adipose (fatty) covers all body surfaces except for the palms of
tissue, and connects the skin to underlying the hands and the soles of the foot. Due to genet-
muscles. ics, male (and some female) individuals may
experience alopecia or baldness, a permanent
The integumentary system has two main loss of hair on the scalp. Nails protect the fingers
types of glands: sudoriferous and sebaceous. The and toes from injury. They are made of dead,
sudoriferous glands (sweat glands) are coiled keratinized epidermal epithelial cells packed
tubes that extend through the dermis and open closely together to form a thick, dense surface.
on the surface of the skin at pores. The sweat, or They are formed in the nail bed. If lost, nails will
perspiration, eliminated by these glands contains regrow if the nail bed is not damaged.
water, salts, and some body wastes. Even though
sweat contains body wastes, it is basically odor-
less. However, when the sweat interacts with bac-
teria on the skin, body odor occurs. The process
of perspiration removes excess water from the
FUNCTIONS
body and cools the body as the sweat evaporates The integumentary system performs the follow-
into the air. The sebaceous glands are oil glands ing important functions:
that usually open onto hair follicles. They pro-
duce sebum, an oil that keeps the skin and hair ♦ Protection: It serves as a barrier to the sun’s
from becoming dry and brittle. Because sebum is ultraviolet rays and the invasion of pathogens,
slightly acidic, it acts as an antibacterial and anti- or germs. It also holds moisture in and pre-
fungal secretion to help prevent infections. When vents deeper tissues from drying out.
an oil gland becomes plugged, the accumulation ♦ Sensory perception: The nerves in the skin help
of dirt and oil results in a blackhead or pimple. the body respond to pain, pressure, tempera-
Two other parts of the integumentary system ture (heat and cold), and touch sensations
are the hair and nails. Each hair consists of a root (figure 7-10).
15 sebaceous
glands
1 yard of
blood vessels
10 hairs
700
sweat
glands
3,000,000
cells 3,000
sensory
cells at
the end
1 square centimeter of nerve
of skin contains: fibers
12 sensory
apparatuses 4 yards
for heat of nerves
2 sensory
apparatuses 25 pressure
for cold apparatus for the
200 nerve perception of tactile
endings stimuli
to record pain
FIGURE 7-10 The nerves in the skin allow the body to respond to many different sensations.
♦ Body temperature regulation: The blood ves-

sels in the skin help the body retain or lose PIGMENTATION
heat. When the blood vessels dilate (get Basic skin color is inherited and is determined by
larger), excess heat from the blood can escape pigments in the epidermis of the skin. A brownish
through the skin. When the blood vessels con- black pigment, melanin, is produced in the epi-
strict (get smaller), the heat is retained in the dermis by specialized cells called melanocytes.
body. The sudoriferous glands also help cool Even though everyone has the same number of
the body through evaporation of perspira- melanocytes, genes present in each racial group
tion. determine the amount of melanin produced. Mel-
♦ Storage: The skin has tissues for temporary anin can lead to a black, brown, or yellow skin tint,
storage of fat, glucose (sugar), water, vitamins, depending on the amount of melanin present and
and salts. Adipose (fatty) tissue in the subcu- racial origin. Ultraviolet light activates the melano-
taneous fascia is a source of energy. cytes to produce more melanin to protect and to
♦ Absorption: Certain substances can be tan the skin. Small concentrated areas of melanin
absorbed through the skin, such as medica- pigment form freckles. Carotene, a yellowish red
tions for motion sickness or heart disease and pigment, also helps determine skin color. A person
nicotine patches to help stop smoking. The with an absence of color pigments is an albino.
medications are placed on sticky patches and An albino’s skin has a pinkish tint and the hair is
applied to the skin. This is called a transder- pale yellow or white. The person’s eyes also lack
mal medication. pigment and are red and very sensitive to light.
Abnormal colors of the skin can indicate dis-
♦ Excretion: The skin helps the body eliminate ease. Erythema is a reddish color of the skin that
salt, a minute amount of waste, and excess can be caused by either burns or a congestion of
water and heat through perspiration. blood in the vessels. Jaundice, a yellow discolor-
♦ Production: The skin helps in the production ation of the skin, can indicate bile in the blood as
of vitamin D by using ultraviolet rays from the a result of liver or gallbladder disease. Jaundice
sun to form an initial molecule of vitamin D also occurs in conjunction with certain diseases
that matures in the liver. that involve the destruction of red blood cells.
154 CHAPTER 7
Cyanosis is a bluish discoloration of the skin and cracks into open sores. Treatment involves
caused by insufficient oxygen. It can be associ- applying an antifungal medication and keeping
ated with heart, lung, and circulatory diseases or the area clean and dry.
disorders. Chronic poisoning may cause a gray or
brown skin discoloration.
Skin Cancer
SKIN ERUPTIONS Cancer of the skin is the most common type of
cancer. There are three main types of skin cancer:
Skin eruptions can also indicate disease. The basal cell carcinoma, squamous cell carcinoma,
most common eruptions include: and melanoma. Basal cell carcinoma is cancer of
the basal cells in the epidermis of the skin. It
♦ Macules: (macular rash) flat spots on the grows slowly and does not usually spread (figure
skin, such as freckles 7-11). The lesions can be pink to yellow-white.
♦ Papules: (papular rash) firm, raised areas They are usually smooth with a depressed center
such as pimples and the eruptions seen in and an elevated, irregular-shaped border.
some stages of chickenpox and syphilis Squamous cell carcinoma affects the thin cells
♦ Vesicles: blisters, or fluid-filled sacs, such as of the epithelium but can spread quickly to other
those seen in chickenpox areas of the body. The lesions start as small, firm,
red, flat sores that later scale and crust (figure
♦ Pustules: pus-filled sacs such as those seen 7-12). Sores that do not heal are frequently squa-
in acne, or pimples mous cell carcinomas.
♦ Crusts: areas of dried pus and blood, com- Melanoma develops in the melanocytes of
monly called scabs the epidermis and is the most dangerous type of
♦ Wheals: itchy, elevated areas with an irregu-
lar shape; hives and insect bites are examples
♦ Ulcer: a deep loss of skin surface that may
extend into the dermis; may cause periodic
bleeding and the formation of scars
DISEASES AND
ABNORMAL CONDITIONS
Acne Vulgaris FIGURE 7-11 Basal cell carcinomas usually grow
more slowly. (Courtesy of Robert A. Silverman, MD,
Acne vulgaris is an inflammation of the seba- Clinical Associate Professor, Department of Pediat-
ceous glands. Although the cause is unknown, rics, Georgetown University)
acne usually occurs at adolescence. Hormonal
changes and increased secretion of sebum are
probably underlying causes. Symptoms include
papules, pustules, and blackheads. These occur
when the hair follicles become blocked with dirt,
cosmetics, excess oil, and/or bacteria. Treatment
methods include frequent, thorough skin wash-
ing; avoidance of creams and heavy makeup;
antibiotic or vitamin A ointments; oral antibiot-
ics; and/or ultraviolet light treatments.
Athlete’s Foot FIGURE 7-12 Squamous cell carcinomas resem-

ble sores that scale and crust. (Courtesy of Robert
Athlete’s foot is a contagious fungal infection that A. Silverman, MD, Clinical Associate Professor,
usually affects the feet. The skin itches, blisters, Department of Pediatrics, Georgetown University)
FIGURE 7-13 Melanoma is the most dangerous

form of skin cancer. (Courtesy of Robert A. Silver-
man, MD, Clinical Associate Professor, Department
of Pediatrics, Georgetown University)
FIGURE 7-14 A contact dermatitis caused by

skin cancer (figure 7-13). The lesions can be contact with poison oak. (Courtesy of Timothy
brown, black, pink, or multicolored. They are Berger, MD, Clinical Professor, Department of
usually flat or raised slightly, asymmetric and Dermatology, University of California, San Fran-
irregular or notched on the edges. cisco)
Frequently, skin cancer develops from a mole
or nevus that changes in color, shape, size, or tex-
ture. Bleeding or itching of a mole can also indi-
cate cancer. Exposure to the sun, prolonged use
of tanning beds, irritating chemicals, or radiation crusts, and scaling. Treatment involves removing
are the usual causes of skin cancer. Treatment the irritant and applying corticosteroids to reduce
involves surgical removal of the cancer, radiation, the inflammatory response.
and/or chemotherapy.
Impetigo
Dermatitis Impetigo is a highly contagious skin infection
Dermatitis, an inflammation of the skin, can be usually caused by streptococci or staphylococci
caused by any substance that irritates the skin. It organisms. Symptoms include erythema, oozing
is frequently an allergic reaction to detergents, vesicles, pustules, and the formation of a yellow
cosmetics, pollen, or certain foods. One example crust. Lesions should be washed with soap and
of contact dermatitis is the irritation caused by water and kept dry. Antibiotics, both topical and
contact with poison ivy, poison sumac, or poison oral, are also used in treatment.
oak (figure 7-14). Symptoms include dry skin, ery-
thema, itching, edema, macular-papular rashes,
and scaling. Treatment is directed at eliminating Psoriasis
the cause, especially in the case of allergens. Anti- Psoriasis is a chronic, noncontagious skin disease
inflammatory ointments, antihistamines, and/or with periods of exacerbations (symptoms pres-
steroids are also used in treatment. ent) and remission (symptoms decrease or disap-
pear). The cause is unknown, but there may be a
hereditary link. Stress, cold weather, sunlight,
Eczema pregnancy, and endocrine changes tend to cause
Eczema is a noncontagious, inflammatory skin an exacerbation of the disease. Symptoms include
disorder caused by an allergen or irritant. Diet, thick, red areas covered with white or silver scales,
cosmetics, soaps, medications, and emotional (figure 7-15). Although there is no cure, treatment
stress can all cause eczema. Symptoms include methods include coal/tar or cortisone ointments,
dryness, erythema, edema, itching, vesicles, ultraviolet light, and/or scale removal.
156 CHAPTER 7
Ringworm
Ringworm (tineas) is a highly contagious fungal
infection of the skin or scalp. The characteristic
symptom is the formation of a flat or raised circu-
lar area with a clear central area surrounded by
an itchy, scaly, or crusty outer ring. Antifungal
medications, both oral and topical, are used in
treatment.
Verrucae
Verrucae, or warts, are caused by a viral infection
of the skin. Plantar warts usually occur at pres-
sure points on the sole of the foot. A rough, hard,
elevated, rounded surface forms on the skin.
Some warts disappear spontaneously, but others
must be removed with electricity, liquid nitrogen,
acid, chemicals, or laser.
FIGURE 7-15 Psoriasis is characterized by white STUDENT: Go to the workbook and complete
or silver scales. (Courtesy of Robert A. Silverman, the assignment sheet for 7:3, Integumentary
MD, Pediatric Dermatology, Georgetown University) System.
♦ Name the two divisions of the skeletal system

7:4 Skeletal System and the main groups of bones in each divi-
Objectives sion

♦ Identify the main bones of the skeleton
to: ♦ Compare the three classifications of joints by
describing the type of motion allowed by
♦ List five functions of bones each
♦ Label the parts of a bone on a diagram of a ♦ Give one example of each joint classification
long bone
♦ Describe at least four diseases of the skeletal
system
KEY TERMS
appendicular skeleton fibula (fib!-you-la) metatarsals
(ap-pen-dick!-u-lar) fontanels (met-ah-tar!-sulz)
axial skeleton foramina (for-ahm!-e-nah) os coxae (ahs cock!-see)
carpals humerus (hue!-mer-us) patella (pa-tell!-ah)
clavicles (klav!-ih-kulz) joints periosteum
cranium ligaments (per-ee-os!-tee-um)
diaphysis (dy-af!-eh-sis) medullary canal phalanges (fa-lan!-jeez)
endosteum (en-dos!-tee-um) (med!-hue-lair-ee) radius
epiphysis (ih-pif!-eh-sis) metacarpals red marrow
femur (fee!-mur) (met-ah-car!-pulz) ribs
(continues)
KEY TERMS (continued)

scapula sutures ulna
sinuses (sigh!-nuss-ez) tarsals vertebrae (vur!-teh-bray)
skeletal system tibia yellow marrow
sternum

◆ Athletic Trainer ◆ Osteopathic Physician ◆ Prosthetist
◆ Chiropractor ◆ Physiatrist ◆ Radiologic Technologist
◆ Orthopedist ◆ Physical Therapist ◆ Sports Medicine Physician
◆ Orthoptist ◆ Podiatrist
or white blood cells. The endosteum is a mem-

7:4 INFORMATION brane that lines the medullary canal and keeps
The skeletal system is made of organs called the yellow marrow intact. It also produces some
bones. An adult human has 206 bones. These bone growth. Red marrow is found in certain
bones work as a system to perform the following bones, such as the vertebrae, ribs, sternum, and
functions: cranium, and in the proximal ends of the humerus
and femur. It produces red blood cells (erythro-
♦ Framework: bones form a framework to sup- cytes), platelets (thrombocytes), and some white
port the body’s muscles, fat, and skin blood cells (leukocytes). Because bone marrow is
♦ Protection: bones surround vital organs to important in the manufacture of blood cells and
protect them (for example the skull, which is involved with the body’s immune response, the
surrounds the brain, and the ribs, which pro- red marrow is used to diagnose blood diseases
tect the heart and lungs) and is sometimes transplanted in people with
defective immune systems. The outside of bone
♦ Levers: muscles attach to bones to help pro- is covered with a tough membrane, called the
vide movement periosteum, which contains blood vessels,
♦ Production of blood cells: bones help produce lymph vessels, and osteoblasts, special cells that
red and white blood cells and platelets, a pro- form new bone tissue. The periosteum is neces-
cess called hemopoiesis or hematopoiesis sary for bone growth, repair, and nutrition. A thin
♦ Storage: bones store most of the calcium sup- layer of articular cartilage covers the epiphysis
ply of the body in addition to phosphorus and and acts as a shock absorber when two bones
fats meet to form a joint.
The skeletal system is divided into two sec-
Bones vary in shape and size depending on tions: the axial skeleton and the appendicular
their locations within the body. Bones of the skeleton. The axial skeleton forms the main
extremities (arms and legs) are called long bones. trunk of the body and is composed of the skull,
The basic parts of these bones are shown in figure spinal column, ribs, and breastbone. The appen-
7-16. The long shaft is called the diaphysis, and dicular skeleton forms the extremities and is
the two extremities, or ends, are each called an composed of the shoulder girdle, arm bones, pel-
epiphysis. The medullary canal is a cavity in vic girdle, and leg bones.
the diaphysis. It is filled with yellow marrow, The skull is composed of the cranial and facial
which is mainly a storage area for fat cells. Yellow bones (figure 7-17). The cranium is the spheri-
marrow also contains cells that form leukocytes, cal structure that surrounds and protects the
158 CHAPTER 7
Articular brain. It is made of eight bones: one frontal, two

cartilage parietal, two temporal, one occipital, one eth-
Proximal
epiphysis moid, and one sphenoid. At birth, the cranium is
Red not solid bone. Spaces called fontanels, or “soft
marrow
spots,” allow for the enlargement of the skull as
Spongy bone brain growth occurs. The fontanels are made of
(contains membrane and cartilage, and turn into solid bone
red marrow)
by approximately 18 months of age. There are 14
facial bones: 1 mandible (lower jaw), 2 maxilla
Medullary cavity (upper jaw), 2 zygomatic (cheek), 2 lacrimal
(contains (inner aspect of eyes), 5 nasal, and 2 palatine
yellow marrow)
(hard palate or roof of the mouth). Sutures are
Artery
areas where the cranial bones have joined
together. Sinuses are air spaces in the bones of
Compact bone tissue
the skull that act as resonating chambers for the
Diaphysis
voice. They are lined with mucous membranes.
Foramina are openings in bones that allow
Endosteum
nerves and blood vessels to enter or leave the
bone.
The spinal column is composed of 26 bones
Yellow called vertebrae (figure 7-18). These bones pro-
marrow tect the spinal cord and provide support for the
head and trunk. They include 7 cervical (neck),
Periosteum 12 thoracic (chest), 5 lumbar (waist), 1 sacrum
(back of pelvic girdle), and 1 coccyx (tailbone).
Pads of cartilage tissue, called intervertebral disks,
separate the vertebrae. The disks act as shock
Distal absorbers and permit bending and twisting
epiphysis movements of the vertebral column.
There are 12 pairs of ribs, or costae. They
FIGURE 7-16 Anatomic parts of a long bone. attach to the thoracic vertebrae on the dorsal sur-
Coronal suture Frontal bone

Parietal bone Sphenoid bone
Squamous suture Ethmoid bone
Nasal bone
Lambdoidal suture
Lacrimal bone
Occipital bone
Maxilla
Zygomatic bone
Temporal bone
External auditory Mandible

meatus
Mastoid process Styloid
of temporal bone process Mental foramen
FIGURE 7-17 Bones of the skull.
C-1 –Atlas Bones of each arm include one humerus

C-2 –Axis (upper arm), one radius (lower arm on thumb
C-3
C-4 Cervical vertebrae side that rotates around the ulna to allow the
C-5 (cervic/o)
C-6 hand to turn freely), one ulna (larger bone of
C-7 lower arm with a projection called the olecranon
T-1
T-2 process at its upper end, forming the elbow), eight
T-3 carpals (wrist), five metacarpals (palm of the
T-4
hand), and fourteen phalanges (three on each
T-5
T-6 finger and two on the thumb).
T-7 Thoracic vertebrae The pelvic girdle is made of two os coxae
T-8 (thorac/o) (coxal, or hip, bones), which join with the sacrum
T-9 on the dorsal part of the body (figure 7-19). On
T-10 the ventral part of the body, the os coxae join
T-11
together at a joint called the symphysis pubis.
T-12
Each os coxae is made of three fused sections: the
L-1
ilium, the ischium, and the pubis. The pelvic gir-
Intervertebral
disk L-2 dle contains two recessed areas, or sockets. These
sockets, called acetabula, provide for the attach-
L-3 Lumbar vertebrae
Vertebral
lumb/o
ment of the smooth rounded head of the femur
body
L-4 (upper leg bone). An opening between the
ischium and pubis, called the obturator foramen,
L-5
allows for the passage of nerves and blood vessels
to and from the legs.
Sacrum
(sacr/o) Each leg consists of one femur (thigh), one
patella (kneecap), one tibia (the larger weight-
Coccyx
(coccyg/o) bearing bone of the lower leg commonly called
the shin bone), one fibula (the slender smaller
FIGURE 7-18 Lateral view of the vertebral, or
spinal, column.
bone of the lower leg that attaches to the proxi-
mal end of the tibia), seven tarsals (ankle), five
metatarsals (instep of foot), and fourteen pha-
langes (two on the great toe and three on each of
the other four toes). The heel is formed by the
face of the body. The first seven pairs are called large tarsal bone called the calcaneous. The bones
true ribs because they attach directly to the ster- of the skeleton are shown in figure 7-20.
num, or breastbone, on the front of the body. The
next five pairs are called false ribs. The first three
pairs of false ribs attach to the cartilage of the rib
above. The last two pairs of false ribs are called
Sacrum
floating ribs because they have no attachment on (sacr/o) Sacroiliac joint
the front of the body. Iliac crest
The sternum, or breastbone, is the last bone (ili/o)
of the axial skeleton. It consists of three parts: the
manubrium (upper region), the gladiolus (body), Anterior
superior
and the xiphoid process (a small piece of carti-
iliac
lage at the bottom). The two collarbones, or clav- spine
icles, are attached to the manubrium by ligaments. Ilium
(ili/o) Coccyx
The ribs are attached to the sternum with costal (coccyg/o)
cartilages to form a “cage” that protects the heart Ischial spine
and lungs. Acetabulum
(ischi/o)
The shoulder, or pectoral, girdle is made of Obturator foramen
Ischium
two clavicles (collarbones) and two scapulas (ischi/o) Symphysis pubis
(shoulder bones). The scapulas provide for (pub/o)
attachment of the upper arm bones. FIGURE 7-19 Anterior view of the pelvic girdle.
160 CHAPTER 7
SKULL Cranium Parietal

Zygomatic
bone Maxilla
Occipital
SHOULDER GIRDLE
Mandible
Clavicle
Acromion process
Scapula
THORAX Scapula
Xiphoid process Sternum
Costal cartilage Ribs
VERTEBRAL
VERTEBRAL UPPER COLUMN
COLUMN EXTREMITY Olecranon
Humerus process
Ilium
Ulna PELVIC
Radius GIRDLE
Sacrum
Carpals
Pubis
Ischium Coccyx
Symphysis
pubis Metacarpals Phalanges
Femur LOWER EXTREMITY Femur
Femur
Patella
Tibia Lateral condyle
Fibula Medial condyle
Tarsals
Metatarsals
Lateral maleolus
Phalanges
Medial maleolus
Calcaneus
FIGURE 7-20 Bones of the skeleton.
Joints ♦ Synarthrosis: immovable; examples are the

suture joints of the cranium
Joints are areas where two or more bones join
together. Connective tissue bands, called liga-
ments, help hold long bones together at joints.
There are three main types of joints: DISEASES AND
♦ Diarthrosis or synovial: freely movable; exam- ABNORMAL CONDITIONS
ples include the ball-and-socket joints of the
shoulder and hip, or the hinge joints of the Arthritis
elbow and knee Arthritis is actually a group of diseases involving
♦ Amphiarthrosis: slightly movable; examples inflammation of the joints. Two main types are
include the attachment of the ribs to the tho- osteoarthritis and rheumatoid arthritis. Osteoar-
racic vertebrae and the symphysis pubis, or thritis, the most common form, is a chronic dis-
joint between the two pelvic bones ease that usually occurs as a result of aging. It
frequently affects the hips and knees. Symptoms Fractures

include joint pain, stiffness, aching, and limited
range of motion. Although there is no cure, rest, A fracture is a crack or break in a bone. Types of
applications of heat and cold, aspirin and anti- fractures, shown in figure 7-22, include:
inflammatory medications, injection of steroids ♦ Greenstick: bone is bent and splits, causing a
into the joints, and special exercises are used to crack or incomplete break; common in chil-
relieve the symptoms. Rheumatoid arthritis is a dren
chronic inflammatory disease that affects the
♦ Simple or closed: complete break of the bone
connective tissues and joints. It is three times
with no damage to the skin
more common in women than in men, and onset
often occurs between the ages of 35 and 45. Pro- ♦ Compound or open: bone breaks and ruptures
gressive attacks can cause scar tissue formation through the skin; creates an increased chance
and atrophy of bone and muscle tissue, which of infection
result in permanent deformity and immobility ♦ Impacted: broken bone ends jam into each
(figure 7-21). Early treatment is important to other
reduce pain and limit damage to joints. Rest, pre-
♦ Comminuted: bone fragments or splinters into
scribed exercise, anti-inflammatory medications
more than two pieces
such as aspirin, and careful use of steroids are the
main forms of treatment. Surgery, or arthroplasty, ♦ Spiral: bone twists, resulting in one or more
to replace damaged joints, such as those in the breaks; common in skiing and skating acci-
hips and knees, is sometimes performed when dents
severe joint damage has occurred. ♦ Depressed: a broken piece of skull bone moves
inward; common with severe head injuries
Bursitis ♦ Colles: breaking and dislocation of the distal

radius that causes a characteristic bulge at the
Bursitis is an inflammation of the bursae, which wrist; caused by falling on an outstretched
are small, fluid-filled sacs surrounding the joints. hand
It frequently affects the shoulders, elbows, hips,
Before a fracture can heal, the bone must be
or knees. Symptoms include severe pain, limited
put back into its proper alignment. This process
movement, and fluid accumulation in the joint.
is called reduction. Closed reduction involves
Treatment consists of administering pain medi-
positioning the bone in correct alignment, usu-
cations, injecting steroids and anesthetics into
ally with traction, and applying a cast or splint to
the affected joint, rest, aspirating (withdrawing
maintain the position until the fracture heals.
fluid with a needle) the joint, and physical ther-
Open reduction involves surgical repair of the
apy to preserve joint motion.
bone. In some cases, special pins, plates, or other
devices are surgically implanted to maintain cor-
rect position of the bone.
Dislocation
A dislocation is when a bone is forcibly displaced
from a joint. It frequently occurs in shoulders,
fingers, knees, and hips. After the dislocation is
reduced (the bone is replaced in the joint), the
dislocation is immobilized with a splint, a cast, or
traction.
Sprain
A sprain is when a twisting action tears the liga-
FIGURE 7-21 Rheumatoid arthritis can cause ments at a joint. The wrists and ankles are com-
permanent deformity and immobility. mon sites for sprains. Symptoms include pain,
162 CHAPTER 7
Transverse
Oblique
(A) Greenstick (B) Closed (C) Open (D) Impacted (E) Comminuted (F) Spiral
(incomplete) (simple, complete) (compound)
(G) Depressed (H) Colles

FIGURE 7-22 Types of fractures.
swelling, discoloration, and limited movement. Osteoporosis

Treatment methods include rest, elevation,
immobilization with an elastic bandage or splint, Osteoporosis, or increased porosity or softening
and/or cold applications. of the bones, is a metabolic disorder caused by a
hormone deficiency (especially estrogen in
women), prolonged lack of calcium in the diet,
and a sedentary lifestyle. The loss of calcium and
Osteomyelitis phosphate from the bones causes the bones to
Osteomyelitis is a bone inflammation usually become porous, brittle, and prone to fracture.
caused by a pathogenic organism. The infectious Bone density tests lead to early detection and
organisms cause the formation of an abscess preventative treatment for osteoporosis. Treat-
within the bone and an accumulation of pus in ment methods include increased intake of cal-
the medullary canal. Symptoms include pain at cium and vitamin D, medications such as
the site, swelling, chills, and fever. Antibiotics are Fosamax and Citracel to increase bone mass,
used to treat the infection. exercise, and/or estrogen replacement.
A. Scoliosis B. Lordosis C. Kyphosis

FIGURE 7-23 Abnormal curvatures of the spinal column.
Ruptured Disk spine to permanently immobilize the affected

vertebrae.
A ruptured disk, also called a herniated or slipped
disk, occurs when an intervertebral disk (pad of
cartilage separating the vertebrae) ruptures or Spinal Curvatures
protrudes out of place and causes pressure on the
spinal nerve. The most common site is at the lum- Abnormal curvatures of the spinal column
bar–sacral area, but a ruptured disk can occur any- include kyphosis, scoliosis, and lordosis (figure
where on the spinal column. Symptoms include 7-23). Kyphosis, or “hunchback,” is a rounded
severe pain, muscle spasm, impaired movement, bowing of the back at the thoracic area. Scoliosis
and/or numbness. Pain, anti-inflammatory, and is a side-to-side, or lateral, curvature of the spine.
muscle relaxant medications may be used as ini- Lordosis, or “swayback,” is an abnormal inward
tial forms of treatment. Other treatments include curvature of the lumbar region. Poor posture,
rest, traction, physical therapy, massage therapy, congenital (at birth) defects, structural defects of
chiropractic treatment, and/or heat or cold the vertebrae, malnutrition, and degeneration of
applications. A laminectomy, surgical removal of the vertebrae can all be causes of these defects.
the protruding disk, may be necessary in severe Therapeutic exercises, firm mattresses, and/or
cases that do not respond to conservative treat- braces are the main forms of treatment. Severe
ment. If pain persists, a spinal fusion may be per- deformities may require surgical repair.
formed to insert a screw/rod assembly into the
STUDENT: Go to the workbook and complete
the assignment sheet for 7:4, Skeletal System.
7:5 Muscular System ♦ List at least three functions of muscles

Objectives ♦ Describe the two main ways muscles attach to
After completing this section, you should be able bones
to: ♦ Demonstrate the five major movements per-
♦ Compare the three main kinds of muscle by formed by muscles
describing the action of each ♦ Describe at least three diseases of the muscu-
♦ Differentiate between voluntary muscle and lar system
involuntary muscle ♦ Define, pronounce, and spell all key terms
164 CHAPTER 7
KEY TERMS
abduction (ab-duck!-shun) excitability muscular system
adduction (ad-duck!-shun) extensibility origin
cardiac muscle extension rotation
circumduction fascia (fash!-ee"-ah) skeletal muscle
contract (con-trackt!) flexion (flek!-shun) tendons
contractibility insertion visceral (smooth) muscle
contracture (con-track!-shur) involuntary voluntary
elasticity muscle tone

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◆ Massage Therapist
◆ Physical Therapist
the blood vessels and eyes. Visceral muscle con-

7:5 INFORMATION tracts to cause movement in these organs. Cardiac
More than 600 muscles make up the system muscle and visceral muscle are involuntary,
known as the muscular system. Muscles are meaning they function without conscious thought
bundles of muscle fibers held together by con- or control. Skeletal muscle is attached to bones
nective tissue. All muscles have certain proper- and causes body movement. Skeletal muscle is
ties or characteristics: voluntary because a person has control over its
action. Because cardiac muscle and visceral mus-
♦ Excitability: irritability, the ability to respond cle are discussed in sections on other systems, the
to a stimulus such as a nerve impulse following concentrates on skeletal muscle.
♦ Contractibility: muscle fibers that are stim- Skeletal muscles perform four important
ulated by nerves contract, or become short functions:
and thick, which causes movement
♦ Attach to bones to provide voluntary move-
♦ Extensibility: the ability to be stretched ment
♦ Elasticity: allows the muscle to return to its ♦ Produce heat and energy for the body
original shape after it has contracted or
stretched
♦ Help maintain posture by holding the body
erect
There are three main kinds of muscle: cardiac,
♦ Protect internal organs
visceral, and skeletal (figure 7-24). Cardiac mus-
cle forms the walls of the heart and contracts to Skeletal muscles attach to bones in different
circulate blood. Visceral, or smooth, muscle is ways. Some attach by tendons, which are strong,
found in the internal organs of the body, such as tough, fibrous connective-tissue cords. An exam-
those of the digestive and respiratory systems, and ple is the gastrocnemius muscle on the calf of the
Spindle-shaped cell Nucleus A cell (fiber)

(fiber)
Centrally
located
nucleus
Striations
Cell (fiber) membrane (cross-stripes)
(A) Smooth muscle fibers (nonstriated)
Branching
of cell
Intercalated
disc
(C) Cardiac muscle fibers (striated)
Many nuclei per Striations A cell (fiber)

cell (fiber) (cross-stripes)
(B) Skeletal muscle fibers (striated)
FIGURE 7-24 Three main kinds of muscle.
leg, which attaches to the heelbone by the Achilles ♦ Circumduction: moving in a circle at a joint,
tendon. Other muscles attach by fascia, a tough, or moving one end of a body part in a circle
sheetlike membrane that covers and protects the while the other end remains stationary, such
tissue. Examples include the deep muscles of the as swinging an arm in a circle
trunk and back, which are surrounded by the lum-
bodorsal fascia. When a muscle attaches to a bone, The major superficial muscles of the body are
the end that does not move is called the origin. shown in figure 7-26; the locations and actions of
The end that moves when the muscle contracts is the major muscles are noted in table 7-2.
called the insertion. For example, the origin of Muscles are partially contracted at all times,
the shoulder muscle, called the deltoid, is by the even when not in use. This state of partial con-
clavicle and scapula. Its insertion is on the humerus. traction is called muscle tone and is sometimes
When the deltoid contracts, the area by the scapula described as a state of readiness to act. Loss of
remains stationary, but the area by the humerus muscle tone can occur in severe illness such as
moves and abducts the arm away from the body. paralysis. When muscles are not used for a long
A variety of different actions or movements period, they can atrophy (shrink in size and lose
performed by muscles are shown in figure 7-25 strength). Lack of use can also result in a con-
and are described as follows: tracture, a severe tightening of a flexor muscle
resulting in bending of a joint. Foot drop is a com-
♦ Adduction: moving a body part toward the mon contracture, but the fingers, wrists, knees,
midline and other joints can also be affected.
♦ Abduction: moving a body part away from
the midline
♦ Flexion: decreasing the angle between two
DISEASES AND
bones, or bending a body part ABNORMAL CONDITIONS
♦ Extension: increasing the angle between two
bones, or straightening a body part Fibromyalgia
♦ Rotation: turning a body part around its own Fibromyalgia is chronic, widespread pain in spe-
axis; for example, turning the head from side cific muscle sites. Other symptoms include mus-
to side cle stiffness, numbness or tingling in the arms or
166 CHAPTER 7
Rotation Abduction Adduction
Extension Flexion
FIGURE 7-25 Types of muscle movement.
TABLE 7-2 Locations and Functions of Major Muscles of the Body

MUSCLE LOCATION FUNCTION
Sternocleidomastoid Side of neck Turns and flexes head

Trapezius Upper back and neck Extends head, moves shoulder
Deltoid Shoulder Abducts arm, injection site
Biceps brachii Upper arm Flexes lower arm and supinates hand
Triceps brachii Upper arm Extends and adducts lower arm
Pectoralis major Upper chest Adducts and flexes upper arm
Intercostals Between ribs Moves ribs for breathing
Rectus abdominus Ribs to pubis (pelvis) Compresses abdomen and flexes vertebral column
Latissimus dorsi Spine around to chest Extends and adducts upper arm
Gluteus maximus Buttocks Extends and rotates thigh, injection site
Sartorius Front of thigh Abducts thigh, flexes leg
Quadriceps femoris Front of thigh Extends leg, injection site
Tibialis anterior Front of lower leg Flexes and inverts foot
Gastrocnemius Back of lower leg Flexes and supinates sole of the foot
Masseter
Sternocleidomastoid
Trapezius
Pectoralis
major Deltoid Teres major
Biceps
Infraspinatus
Triceps Triceps
Serratus lateral head
anterior Latissimus
Gluteus dorsi
maximus
External Rectus
oblique abdominis
Biceps
Adductor Rectus Iliotibial femoris
longus femoris band
Sartorius Vastus Semitendinosus

medialis
Vastus
lateralis Tibialis Gastrocnemius
anterior
Gastrocnemius
Soleus
Achilles
tendon
Anterior Surface Muscles Posterior Surface Muscles

FIGURE 7-26 Main muscles of the body.
legs, fatigue, sleep disturbances, headaches, and loses the ability to move. The onset usually occurs
depression. The cause is unknown, but stress, between 2 and 5 years of age. By age 9 to 12, the
weather, and poor physical fitness affect the con- child is confined to a wheelchair. Eventually, the
dition. Treatment is directed toward pain relief muscle weakness affects the heart and dia-
and includes physical therapy, massage, exercise, phragm, resulting in respiratory and/or cardiac
stress reduction, and medication to relax muscles failure that causes death. The life expectancy is
and relieve pain. usually from the late teens to the early twenties.
Although there is no cure, physical therapy is
used to slow the progress of the disease.
Muscular Dystrophy
Muscular dystrophy is actually a group of inher-
ited diseases that lead to chronic, progressive
Myasthenia Gravis
muscle atrophy. Muscular dystrophy usually Myasthenia gravis is a chronic condition where
appears in early childhood; most types result in nerve impulses are not properly transmitted to
total disability and early death. The most com- the muscles. This leads to progressive muscular
mon type is Duchenne muscular dystrophy, weakness and paralysis. If the condition affects
which is caused by a genetic defect. At birth, the the respiratory muscles, it can be fatal. Although
infant is healthy. As muscle cells die, the child the cause is unknown, myasthenia gravis is
168 CHAPTER 7
thought to be an autoimmune disease, with anti- Strain

bodies attacking the body’s own tissues. There is
no cure, and treatment is supportive. A strain is an overstretching of or injury to a mus-
cle and/or tendon. Frequent sites include the back,
arms, and legs. Prolonged or sudden muscle exer-
tion is usually the cause. Symptoms include myal-
Muscle Spasms gia (muscle pain), swelling, and limited movement.
Muscle spasms, or cramps, are sudden, painful, Treatment methods include rest, muscle relaxants
involuntary muscle contractions. They usually or pain medications, elevating the extremity, and
occur in the legs or feet and may result from over- alternating hot and cold applications.
exertion, low electrolyte levels, or poor circula-
tion. Gentle pressure and stretching of the muscle STUDENT: Go to the workbook and complete
are used to relieve the spasm. the assignment sheet for 7:5, Muscular System.
7:6 Nervous System ♦ Explain three functions of the spinal cord

Objectives ♦ Name the three meninges
After completing this section, you should be able ♦ Describe the circulation and function of cere-
to: brospinal fluid
♦ Identify the four main parts of a neuron ♦ Contrast the actions of the sympathetic and
♦ Name the two main divisions of the nervous parasympathetic nervous systems
system ♦ Describe at least five diseases of the nervous
♦ Describe the function of each of the five main system
parts of the brain ♦ Define, pronounce, and spell all key terms
KEY TERMS
autonomic nervous system hypothalamus parasympathetic (par"-ah-
brain medulla oblongata (meh- sim"-pah-thet!-ik)
central nervous system due!-la ob-lawn-got!-ah) peripheral nervous system
(CNS) meninges (singular: meninx) (PNS) (peh-rif!-eh-ral)
cerebellum (seh"-reh-bell!- (meh-nin!-jeez) pons (ponz)
um) midbrain somatic nervous system
cerebrospinal fluid (seh-ree"- nerves spinal cord
broh-spy!-nal fluid) nervous system sympathetic
cerebrum (seh-ree!-brum) neuron (nur!-on) thalamus
diencephalon ventricles

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◆ Electroneurodiagnostic
◆ Anesthesiologist ◆ Polysomnographic
Technologist Technologist
◆ Chiropractor
◆ Mental Health Technician
◆ Psychiatrist
◆ Diagnostic Imager
◆ Neurologist
◆ Psychologist
◆ Doctor of Osteopathic
Medicine
7:6 INFORMATION Impulses coming from one axon “jump” the syn-
apse to get to the dendrite of another neuron,
The nervous system is a complex, highly orga- which will carry the impulse in the right direc-
nized system that coordinates all the activities of tion. Special chemicals, called neurotransmitters,
the body. This system enables the body to respond located at the end of each axon, allow the nerve
and adapt to changes that occur both inside and impulses to pass from one neuron to another. In
outside the body. this way, impulses can follow many different
The basic structural unit of the nervous sys- routes.
tem is the neuron, or nerve cell (figure 7-27). It Nerves are a combination of many nerve
consists of a cell body containing a nucleus; nerve fibers located outside the brain and spinal cord.
fibers, called dendrites (which carry impulses Afferent, or sensory, nerves carry messages from
toward the cell body); and a single nerve fiber, all parts of the body to the brain and spinal cord.
called an axon (which carries impulses away from Efferent, or motor, nerves carry messages from
the cell body). Many axons have a lipid (fat) cov- the brain and spinal cord to the muscles and
ering called a myelin sheath, which increases the glands. Associative, or internuncial, nerves carry
rate of impulse transmission and insulates and both sensory and motor messages.
maintains the axon. The axon of one neuron lies There are two main divisions to the nervous
close to the dendrites of many other neurons. The system: the central nervous system and the
spaces between them are known as synapses. peripheral nervous system (figure 7-28). The
Dendrites
Nucleus
Axon
Terminal
branches
}
Myelin sheath
Axon
Cell body Myelin
Nodes of Ranvier
Schwann cells
FIGURE 7-27 A neuron, the basic structural unit of the nervous system.
170 CHAPTER 7
Nervous system
CNS PNS
Brain 12 cranial nerve pairs
Spinal cord 31 spinal nerve pairs
Somatic division Autonomic division
Sympathetic Parasympathetic
Sensory neurons Motor neurons

Motor neurons Sensory neurons
Sensory information Motor impulses from
Motor impulses Sensory information
from skin, skeletal CNS to smooth
from CNS to skeletal from visceral organs
muscles and joints muscles, cardiac
muscles to CNS
to CNS muscle and glands
FIGURE 7-28 Divisions of the nervous system.
central nervous system (CNS) consists of the brum is responsible for reasoning, thought,
brain and spinal cord. The peripheral nervous memory, judgment, speech, sensation, sight,
system (PNS) consists of the nerves and has two smell, hearing, and voluntary body move-
divisions: the somatic nervous system and the ment.
autonomic nervous system. The somatic ner- ♦ Cerebellum: the section below the back of
vous system carries messages between the CNS the cerebrum. It is responsible for muscle
and the body. The autonomic nervous system coordination, balance, posture, and muscle
contains the sympathetic and parasympathetic tone.
nervous systems, which work together to control
involuntary body functions. ♦ Diencephalon: the section located between
the cerebrum and midbrain. It contains two
structures: the thalamus and hypothalamus.
CENTRAL NERVOUS The thalamus acts as a relay center and
directs sensory impulses to the cerebrum. It
SYSTEM also allows conscious recognition of pain and
temperature. The hypothalamus regulates
The brain is a mass of nerve tissue well protected and controls the autonomic nervous system,
by membranes and the cranium, or skull (figure temperature, appetite, water balance, sleep,
7-29). The main sections include: and blood vessel constriction and dilation.
♦ Cerebrum: the largest and highest section of The hypothalamus is also involved in emo-
the brain. The outer part is arranged in folds, tions such as anger, fear, pleasure, pain, and
called convolutions, and separated into lobes. affection.
The lobes include the frontal, parietal, tempo- ♦ Midbrain: the section located below the
ral, and occipital, named from the skull bones cerebrum at the top of the brainstem. It is
that surround them (figure 7-30). The cere- responsible for conducting impulses between
Lateral ventricle
Interventricular foramen Convolutions
Sulci
Skull
Dura mater
Arachnoid Meninges
Cerebrum
Pia mater
Corpus callosum
Third ventricle
Cerebral aqueduct
Thalamus
Diencephalon Hypothalamus Fourth ventricle
Pituitary gland
Midbrain
Brain stem Pons Cerebellum
Medulla oblongata
Spinal cord
FIGURE 7-29 The brain and spinal cord.
brain parts and for certain eye and auditory dura mater is the thick, tough, outer layer. The
reflexes. middle layer is delicate and weblike, and is called
♦ Pons: the section located below the midbrain the arachnoid membrane. It is loosely attached to
and in the brainstem. It is responsible for con- the other meninges to allow space for fluid to
ducting messages to other parts of the brain; flow between the layers. The innermost layer, the
for certain reflex actions including chewing, pia mater, is closely attached to the brain and spi-
tasting, and saliva production; and for assist- nal cord, and contains blood vessels that nourish
ing with respiration. the nerve tissue.
The brain has four ventricles, hollow spaces
♦ Medulla oblongata: the lowest part of the that connect with each other and with the space
brainstem. It connects with the spinal cord under the arachnoid membrane (the subarach-
and is responsible for regulating heartbeat, noid space). The ventricles are filled with a clear,
respiration, swallowing, coughing, and blood colorless fluid called cerebrospinal fluid. This
pressure. fluid circulates continually between the ventri-
The spinal cord continues down from cles and through the subarachnoid space. It
the medulla oblongata and ends at the first or serves as a shock absorber to protect the brain
second lumbar vertebrae (figure 7-31). It is sur- and spinal cord. It also carries nutrients to some
rounded and protected by the vertebrae. The spi- parts of the brain and spinal cord and helps
nal cord is responsible for many reflex actions remove metabolic products and wastes. The fluid
and for carrying sensory (afferent) messages up is produced in the ventricles of the brain by the
to the brain and motor (efferent) messages from special structures called choroid plexuses. After
the brain to the nerves that go to the muscles and circulating, it is absorbed into the blood vessels
glands. of the dura mater and returned to the blood-
The meninges are three membranes that stream through special structures called arach-
cover and protect the brain and spinal cord. The noid villi.
172 CHAPTER 7
Sulci
Convolutions of
cerebral hemisphere Parietal lobe
(gyri)
Cerebrum
Frontal lobe
Occipital lobe
Temporal lobe
(A) Midbrain
Brainstem Pons Cerebellum

Medulla
Lateral View
h Sensory
ec
Motor
Spe
Emotions Pain
Personality Heat
Morality Touch
Intellect
Speech
Hearing
Vision
(B)
Smelling
Muscle tone
Relays impulses Equilibrium
Autonomic nervous control Walking
Controls blood pressure Eye reflexes Dancing
Maintains body temperature Conducts impulses Heart
Stimulates antidiuretic hormone Lungs
Assists with appetite regulation Breathing
Stomach
Acts on intestines Chewing
Blood vessels
Role in emotions Taste
Helps maintain wakefulness
FIGURE 7-30 Each lobe of the brain is responsible for different functions.
PERIPHERAL NERVOUS
SYSTEM cranial nerves are responsible for special senses
such as sight, hearing, taste, and smell. Others
The peripheral nervous system consists of the receive general sensations such as touch, pres-
somatic and the autonomic nervous systems. sure, pain, and temperature, and send out
impulses for involuntary and voluntary muscle
control. The spinal nerves carry messages to and
Somatic Nervous System from the spinal cord and are mixed nerves, both
The somatic nervous system consists of 12 pairs sensory (afferent) and motor (efferent). There are
of cranial nerves and their branches, and 31 pairs 8 cervical, 12 thoracic, 5 lumbar, 5 sacral, and 1
of spinal nerves and their branches. Some of the pair of coccygeal spinal nerves. Each nerve goes
DISEASES AND
ABNORMAL
Cervical plexus
C1–C5
CONDITIONSS
Brachial plexus
C5–T1 Amyotrophic Lateral
Sclerosis
Amyotrophic lateral sclerosis (ALS), also known
as Lou Gehrig’s disease, is a chronic, degenerative
neuromuscular disease. The cause is unknown,
but genetic or viral-immune factors are sus-
Lumbar plexus
L1–L4
pected. Nerve cells in the CNS that control vol-
Femoral nerve
untary movement degenerate, resulting in a
weakening and atrophy (wasting away) of the
Sacral plexus
L4–S3
muscles they control. Initial symptoms include
Sciatic nerve muscle weakness, abnormal reflexes, tripping
and falling, impaired hand and arm movement,
and difficulty in speaking or swallowing. As the
disease progresses, more muscles are affected,
FIGURE 7-31 The spinal cord and nerves. resulting in total body paralysis. In the later
stages, the patient loses all ability to communi-
cate, breathe, eat, and move. Mental acuity is
unaffected, so an active mind is trapped inside a
directly to a particular part of the body or net- paralyzed body. No treatment exists, but drugs
works with other spinal nerves to form a plexus such as Riluzole may slow the progress of the dis-
that supplies sensation to a larger segment of the ease. ALS is usually fatal within 4 to 6 years of
body. symptom onset, but some patients with slower
rates of progression have survived 10–20 years
after the onset of the disease.
Autonomic Nervous System
The autonomic nervous system is an important
part of the peripheral nervous system. It helps
maintain a balance in the involuntary functions
Carpal Tunnel Syndrome
of the body and allows the body to react in times Carpal tunnel syndrome is a condition that occurs
of emergency. There are two divisions to the auto- when the medial nerve and tendons that pass
nomic nervous system: the sympathetic and through a canal or “tunnel” on their way from the
parasympathetic nervous systems. These two forearm to the hands and fingers are pinched.
systems usually work together to maintain a bal- Repetitive movement of the wrist causes swelling
anced state, or homeostasis, in the body and to around this tunnel, which puts pressure on the
control involuntary body functions at proper nerves and tendons. Symptoms include pain,
rates. In times of emergency, the sympathetic muscle weakness in the hand, and impaired
nervous system prepares the body to act by movement. A classic symptom is pain, numb-
increasing heart rate, respiration, and blood pres- ness, and tingling in the thumb, ring finger,
sure, and slowing activity in the digestive tract. and middle finger. Initially, carpal tunnel is
This is known as the fight or flight response. After treated with anti-inflammatory medications,
the emergency, the parasympathetic nervous analgesics for pain, and splinting to immobilize
system counteracts the actions of the sympa- the joint. Severe cases that do not respond to this
thetic system by slowing heart rate, decreasing treatment may require surgery to enlarge the
respiration, lowering blood pressure, and increas- “tunnel” and relieve the pressure on the nerves
ing activity in the digestive tract. and tendons.
174 CHAPTER 7
Cerebral Palsy person recover from or adapt to the symptoms

that are present. Physical, occupational, and
Cerebral palsy is a disturbance in voluntary mus- speech therapy are the main forms of treatment.
cle action and is caused by brain damage. Lack of
oxygen to the brain, birth injuries, prenatal
rubella (German measles), and infections can all Encephalitis
cause cerebral palsy. Of the three forms—spastic,
athetoid, and atactic—spastic is the most com- Encephalitis is an inflammation of the brain and
mon. Symptoms include exaggerated reflexes, is caused by a virus, bacterium, chemical agent,
tense muscles, contracture development, sei- or as a complication of measles, chicken pox, or
zures, speech impairment, spasms, tremors, and mumps. The virus is frequently contracted from a
in some cases, mental retardation. Although there mosquito bite because mosquitos can carry the
is no cure, physical, occupational, and speech encephalitis virus. Symptoms vary but may
therapy are important aspects of treatment. Mus- include fever, extreme weakness or lethargy, visual
cle relaxants, anticonvulsive drugs, casts, braces, disturbances, headaches, vomiting, stiff neck and
and/or orthopedic surgery (for severe contrac- back, disorientation, seizures, and coma. Treat-
tures) are also used. ment methods are supportive and include antivi-
ral drugs, maintenance of fluid and electrolyte
balance, antiseizure medication, and monitoring
Cerebrovascular Accident of respiratory and kidney function.
A cerebrovascular accident (CVA), also called a
brain attack, stroke, or apoplexy, occurs when the Epilepsy
blood flow to the brain is impaired, resulting in a
lack of oxygen and a destruction of brain tissue. It Epilepsy, or seizure syndrome, is a brain disorder
can be caused by cerebral hemorrhage resulting associated with abnormal electrical impulses in
from hypertension, an aneurysm, or a weak blood the neurons of the brain. Although causes can
vessel; or by an occlusion, or blockage, caused by include brain injury, birth trauma, tumors, toxins
atherosclerosis or a thrombus (blood clot). Fac- such as lead or carbon monoxide, and infections,
tors that increase the risk for a CVA include smok- many cases of epilepsy are idiopathic (spontane-
ing, a high-fat diet, obesity, and a sedentary ous, or primary). Absence, or petit mal, seizures
lifestyle. Symptoms vary depending on the area are milder and are characterized by a loss of con-
and amount of brain tissue damaged. Some com- sciousness lasting several seconds. They are com-
mon symptoms of an acute CVA include loss of mon in children and frequently disappear by late
consciousness, weakness or paralysis on one side adolescence. Generalized tonic-clonic, or grand
of the body (hemiplegia), dizziness, dysphagia mal, are the most severe seizures. They are char-
(difficult swallowing), visual disturbances, men- acterized by a loss of consciousness lasting sev-
tal confusion, aphasia (speech and language eral minutes; convulsions accompanied by violent
impairment), and incontinence. When a CVA shaking and thrashing movements; hypersaliva-
occurs, immediate care during the first 3 hours tion, causing foaming at the mouth; and loss of
can help prevent brain damage. Treatment with body functions. Some individuals experience an
thrombolytic or “clot-busting” drugs such as TPA aura, such as a particular smell, ringing in the
(tissue plasminogen activator) or angioplasty of ears, visual disturbances, or tingling in the fingers
the cerebral arteries can dissolve a blood clot and and/or toes just before a seizure occurs. Anticon-
restore blood flow to the brain. Computerized vulsant drugs are effective in controlling epilepsy.
tomography (CT) scans (noninvasive computer-
ized X-rays that show cross-sectional views of
body tissue) are used to determine the cause of
Hydrocephalus
the CVA. Clot-busting drugs cannot be used if the Hydrocephalus is an excessive accumulation of
CVA is caused by a hemorrhage. Neuroprotective cerebrospinal fluid in the ventricles and, in some
agents, or drugs that help prevent injury to neu- cases, the subarachnoid space of the brain. It is
rons, are also used initially to prevent permanent usually caused by a congenital (at birth) defect,
brain damage. Additional treatment depends on infection, or tumor that obstructs the flow of
symptoms and is directed toward helping the cerebrospinal fluid out of the brain. Symptoms
include an abnormally enlarged head, prominent numbness. As the disease progresses, tremors,
forehead, bulging eyes, irritability, distended muscle spasticity, paralysis, speech impairment,
scalp veins, and when pressure prevents proper emotional swings, and incontinence occur. There
development of the brain, retardation. The con- is no cure. Treatment methods such as physical
dition is treated by the surgical implantation of a therapy, muscle relaxants, steroids, and psycho-
shunt (tube) between the ventricles and the veins, logical counseling are used to maintain functional
heart, or abdominal peritoneal cavity to provide ability as long as possible.
for drainage of the excess fluid.
Neuralgia
Meningitis Neuralgia is nerve pain. It is caused by inflamma-
Meningitis is an inflammation of the meninges of tion, pressure, toxins, and other disease. Treat-
the brain and/or spinal cord and is caused by a ment is directed toward eliminating the cause of
bacterium, virus, fungus, or toxin such as lead or the pain.
arsenic. Symptoms include high fever, headaches,
back and neck pain and stiffness, nausea and vom-
iting, delirium, convulsions, and if untreated, coma Paralysis
and death. Treatment methods include antibiotics, Paralysis usually results from a brain or spinal
antipyretics (for fever), anticonvulsants, and/or cord injury that destroys neurons and results in a
medications for pain and cerebral edema. loss of function and sensation below the level of
injury. Hemiplegia is paralysis on one side of the
body and is caused by a tumor, injury, or CVA.
Multiple Sclerosis Paraplegia is paralysis in the lower extremities or
Multiple sclerosis (MS) is a chronic, progressive, lower part of the body and is caused by a spinal
disabling condition resulting from a degeneration cord injury. Quadriplegia is paralysis of the arms,
of the myelin sheath in the CNS. It usually occurs legs, and body below the spinal cord injury. Cur-
between the ages of 20 and 40 (figure 7-32). The rently, no cure exists, although much research is
cause is unknown but genetics or a viral infection being directed toward repairing spinal cord dam-
of the immune system are suspected. The disease age. Treatment methods are supportive and
progresses at different rates and has periods of include physical and occupational therapy.
remission. Early symptoms include visual distur-
bances such as diplopia (double vision), weak-
ness, fatigue, poor coordination, and tingling and Parkinson’s Disease
Parkinson’s disease is a chronic, progressive con-
dition involving degeneration of brain cells, usu-
ally in persons over 50 years of age. Symptoms
include tremors, stiffness, muscular rigidity, a for-
ward leaning position, a shuffling gait, difficulty in
stopping while walking, loss of facial expression,
drooling, mood swings and frequent depression,
and behavioral changes. Although no cure exists, a
drug called levodopa is used to relieve the symp-
toms. In some cases, surgery can be performed to
destroy selectively a small area of the brain and
control involuntary movements. Physical therapy
is also used to limit muscular rigidity.
Shingles
Shingles, or herpes zoster, is an acute inflamma-
FIGURE 7-32 Multiple sclerosis usually occurs tion of nerve cells and is caused by the herpes
between the ages of 20 and 40. virus, which also causes chicken pox. It charac-
176 CHAPTER 7
teristically occurs in the thoracic area on one side ness, itching, fever, and abnormal skin sensa-
of the body and follows the path of the affected tions. Treatment is directed toward relieving pain
nerves (figure 7-33). Fluid-filled vesicles appear and itching until the inflammation subsides, usu-
on the skin, accompanied by severe pain, red- ally in 1–4 weeks.

the assignment sheet for 7:6, Nervous System.
7:7 Special Senses

Objectives
to:
♦ Identify five special senses
♦ Label the major parts on a diagram of the eye
♦ Trace the pathway of light rays as they pass
through the eye
♦ Label the major parts on a diagram of the ear
♦ Trace the pathway of sound waves as they
pass through the ear
♦ Explain how the ear helps maintain balance
and equilibrium
♦ State the locations of the four main taste
receptors
♦ List at least four general senses located
throughout the body
♦ Describe at least six diseases of the eye and
FIGURE 7-33 The vesicles of shingles follow the ear
path of the affected nerves. ♦ Define, pronounce, and spell all key terms
KEY TERMS
aqueous humor iris retina (ret!-in-ah)
(a!-kwee"-us hue-more) lacrimal glands sclera (sklee!-rah)
auditory canal (lack!-rih"-mal) semicircular canals
auricle (or!-eh-kul") lens tympanic membrane
choroid coat (koh!-royd) organ of Corti (tim-pan!-ik)
cochlea (co!-klee-ah) ossicles (os!-ick-uls) vestibule (ves!-tih-bewl)
conjunctiva pinna (pin!-nah) vitreous humor
(kon-junk"-tye!-vah) pupil (vit!-ree-us hue!-more)
cornea refracts
eustachian tube
(you-stay!-she-en)

◆ Allergist ◆ Ophthalmic Laboratory ◆ Ophthalmologist
◆ Audiologist
Technician ◆ Optician
◆ Ophthalmic Medical
◆ Eye, Ear, Nose, and Throat ◆ Optometrist
Specialist Technologist
◆ Otolaryngologist
◆ Ophthalmic Technician
◆ Ophthalmic Assistant
◆ Otologist
The eye (figure 7-34A) is well protected. It is

7:7 INFORMATION partially enclosed in a bony socket of the skull.
Special senses allow the human body to react to Eyelids and eyelashes help keep out dirt and
the environment by providing for sight, hearing, pathogens. Lacrimal glands in the eye produce
taste, smell, and balance maintenance. These tears, which constantly moisten and cleanse the
senses are possible because the body has struc- eye. The tears flow across the eye and drain
tures that receive sensations, nerves that carry through the nasolacrimal duct into the nasal cav-
sensory messages to the brain, and a brain that ity. A mucous membrane, called the conjunc-
interprets and responds to sensory messages. tiva, lines the eyelids and covers the front of the
eye to provide additional protection and lubrica-
tion.
THE EYE There are three main layers to the eye (figure
7-34B). The outermost layer is the tough connec-
The eye is the organ that controls the special tive tissue called the sclera. It is frequently
sense of sight. It receives light rays and transmits referred to as the “white” of the eye. The sclera
impulses from the rays to the optic nerve, which maintains the shape of the eye. Extrinsic muscles,
carries the impulses to the brain, where they are responsible for moving the eye within the socket,
interpreted as vision, or sight. are attached to the outside of the sclera. The cor-
Ciliary body and
muscle
Suspensory
ligament
Conjunctiva
Iris
Eyebrow Retina
Lacrimal gland
(under eyelid) Pupil Pupil Retinal arteries
Sclera and veins
(white of eye) Path of light Fovea
Iris centralis
Anterior chamber
(aqueous humor)
Cornea Optic
Nasolacrimal nerve
duct Choroid coat
into nose Lens
Sclera
Suspensory
ligament
Posterior chamber
(A) (vitreous humor) (B)
FIGURE 7-34 (A) External view of the eye; (B) structures of the eye.
178 CHAPTER 7
nea is a circular, transparent part of the front of When light rays enter the eye, they pass
the sclera. It allows light rays to enter the eye. The through a series of parts that refract the rays so
middle layer of the eye, the choroid coat, is that the rays focus on the retina. These parts are
interlaced with many blood vessels that nourish the cornea, the aqueous humor, the pupil, the lens,
the eyes. The innermost layer of the eye is the and the vitreous humor. In the retina, the light rays
retina. It is made of many layers of nerve cells, (image) are picked up by the rods and cones,
which transmit the light impulses to the optic changed into nerve impulses, and transmitted by
nerve. Two such special cells are cones and rods. the optic nerve to the occipital lobe of the cere-
Cones are sensitive to color and are used mainly brum, where sight is interpreted. If the rays are not
for vision when it is light. Most of the cones are refracted correctly by the various parts, vision can
located in a depression located on the back sur- be distorted or blurred (figure 7-35).
face of the retina called the fovea centralis; this is
the area of sharpest vision. Rods are used for
vision when it is dark or dim. Diseases and Abnormal
The iris is the colored portion of the eye. It is
located behind the cornea on the front of the
Conditions
choroid coat. The opening in the center of the iris Amblyopia
is called the pupil. The iris contains two muscles, Amblyopia, or lazy eye, commonly occurs in early
which control the size of the pupil and regulate childhood. It results in poor vision in one eye and
the amount of light entering the eye. is caused by the dominance of the other eye.
Other special structures are also located in Treatment methods include covering the good
the eye. The lens is a circular structure located eye to stimulate development of the “lazy” eye,
behind the pupil and suspended in position by exercises to strengthen the weak eye, corrective
ligaments. It refracts (bends) light rays so the lenses, and/or surgery. If the condition is not
rays focus on the retina. The aqueous humor is treated before 8 to 9 years of age, blindness of the
a clear, watery fluid that fills the space between affected eye may occur.
the cornea and iris. It helps maintain the forward
curvature of the eyeball and refracts light rays. Astigmatism
The vitreous humor is the jellylike substance Astigmatism is an abnormal shape or curvature
that fills the area behind the lens. It helps main- of the cornea that causes blurred vision. Light
tain the shape of the eyeball and also refracts light rays focus on multiple areas of the retina (figure
rays. A series of muscles located in the eye pro- 7-35). Corrective lenses (glasses or contact lenses)
vide for eye movement. correct the condition.
(A) Normal eye (B) Myopia (nearsightedness) (C) Hyperopia (farsightedness)

Light rays focus on the retina Light rays focus in front Light rays focus beyond
of the retina the retina
(D) Presbyopia (E) Astigmatism

Light rays focus Light rays focus on multiple
behind the retina areas of the retina
FIGURE 7-35 Improper refraction of light rays causes impaired vision.
Cataract the image focuses behind the retina (figure 7-35).

A cataract occurs when the normally clear lens Vision is corrected by the use of convex lenses.
becomes cloudy or opaque (figure 7-36). This
occurs gradually, usually as a result of aging, but Macular Degeneration
may be the result of trauma. Symptoms include Macular degeneration, a major cause of vision loss
blurred vision, halos around lights, gradual vision and blindness, is a disease of the macula, the cen-
loss, and in later stages, a milky white pupil. Sight tral and most sensitive section of the retina. It is an
is restored by the surgical removal of the lens. An age-related disorder caused by damage to the
implanted intraocular lens or prescription glasses blood vessels that nourish the retina. The most
or contact lenses correct the vision and compen- common type is dry macular degeneration that
sate for the removed lens. occurs as fatty deposits decrease the blood supply
to the retina, resulting in a gradual thinning of the
Conjunctivitis retina. It progresses slowly and results in blurred
Conjunctivitis, or pink eye, is a contagious inflam- distorted vision with an absence of central vision.
mation of the conjunctiva and is usually caused Peripheral (side) vision is usually not affected. No
by a bacterium or virus. Symptoms include red- treatment currently exists, but optical aids such as
ness, swelling, pain, and, at times, pus formation special lighting or magnifiers may improve vision
in the eye. Antibiotics, frequently in the form of slightly. Wet macular degeneration is caused by an
an eye ointment, are used to treat conjunctivitis. abnormal growth of blood vessels that leak blood
and fluids that damage the retina. Laser treatment
Glaucoma to coagulate or seal the leaking blood vessels can
Glaucoma is a condition of increased intraocular preserve sight. New research directed toward cre-
(within the eye) pressure caused by an excess ation of an artificial retina or bionic eye may allow
amount of aqueous humor. It is common after individuals with this disease to regain the ability to
age 40 and is a leading cause of blindness. A see light and large objects in the future.
tonometer (instrument that measures intraocu-
lar pressure) is usually used during regular eye Myopia
examinations to check for this condition. Symp- Myopia is nearsightedness. It occurs when the
toms include loss of peripheral (side) vision, light rays are refracted too sharply and the image
halos around lights, limited night vision, and focuses in front of the retina (figure 7-35). Vision is
mild aching. Glaucoma is usually controlled with corrected by the use of concave lenses. A newer
medications that decrease the amount of fluid method of treatment is a surgical procedure called
produced or improve the drainage. In some cases, radial keratotomy (RK). Small incisions are made
surgery is performed to create an opening for the in the cornea to flatten it so it can refract light rays
flow of the aqueous humor. correctly. In some cases, a laser is used to flatten
the cornea without cutting. RK can correct myopia
Hyperopia and eliminate the need for corrective lenses.
Hyperopia is farsightedness. It occurs when the
light rays are not refracted sharply enough and Presbyopia
Presbyopia is farsightedness caused by a loss of
lens elasticity. Light rays focus behind the retina
(figure 7-35). It results from the normal aging
process and is treated by the use of corrective
lenses or “reading” glasses.
Strabismus
Strabismus is a disorder in which the eyes do not
move or focus together. The eyes may move
inward (cross-eyed) or outward, or up or down. It
is caused by muscle weakness in one or both eyes.
FIGURE 7-36 A cataract occurs when the lens of Treatment methods include eye exercises, cover-
the eye becomes cloudy or opaque. (Courtesy of ing the good eye, corrective lenses, and/or sur-
National Eye Institute, NEH) gery on the muscles that move the eye.
180 CHAPTER 7
The inner ear is the most complex portion of

THE EAR the ear. It is separated from the middle ear by a
membrane called the oval window. The first sec-
The ear is the organ that controls the special
tion is the vestibule, which acts as the entrance
senses of hearing and balance. It transmits
to the two other parts of the inner ear. The
impulses from sound waves to the auditory nerve
cochlea, shaped like a snail’s shell, contains del-
(vestibulocochlear), which carries the impulses
icate, hairlike cells, which compose the organ of
to the brain for interpretation as hearing. The ear
Corti, a receptor of sound waves. The organ of
is divided into three main sections: the outer ear,
Corti transmits the impulses from sound waves
the middle ear, and the inner ear (figure 7-37).
to the auditory nerve. This nerve carries the
The outer ear contains the visible part of
impulses to the temporal lobe of the cerebrum,
the ear, called the pinna, or auricle. The pinna
where they are interpreted as hearing. Semicir-
is elastic cartilage covered by skin. It leads to
cular canals are also located in the inner ear.
a canal, or tube, called the external auditory
These canals contain a liquid and delicate, hair-
meatus, or auditory canal. Special glands in
like cells that bend when the liquid moves with
this canal produce cerumen, a wax that protects
head and body movements. Impulses sent from
the ear. Sound waves travel through the auditory
the semicircular canals to the cerebellum of the
canal until they reach the eardrum, or tympanic
brain help to maintain our sense of balance and
membrane. The tympanic membrane separates
equilibrium.
the outer ear from the middle ear. It vibrates when
sound waves hit it and transmits the sound waves
to the middle ear.
The middle ear is a small space, or cavity, in Diseases and Abnormal
the temporal bone. It contains three small bones
(ossicles): the malleus, the incus, and the sta-
Conditions
pes. The bones are connected and transmit sound Hearing Loss
waves from the tympanic membrane to the inner Hearing loss is classified as either conductive or
ear. The middle ear is connected to the pharynx, sensory. Conductive hearing loss or deafness
or throat, by a tube called the eustachian tube. occurs when sound waves are not conducted
This tube allows air to enter the middle ear and to the inner ear. Possible causes include a wax
helps equalize air pressure on both sides of the (cerumen) plug, a foreign body obstruction, oto-
tympanic membrane. sclerosis, an infection, or a ruptured tympanic
Incus
Malleus Semicircular
canals
Branches of
vestibulocochlear
Auricle nerve
Cochlea
External Oval window

auditory canal
Round window
Auditory
(eustachian) tube
Tympanic membrane Stapes and footplate

FIGURE 7-37 Structures of the ear.
membrane. Treatment is directed toward eliminat- Symptoms include gradual hearing loss, tinnitus,
ing the cause. Surgery and the use of hearing aids and at times, vertigo. Surgical removal of the sta-
are common forms of treatment. Sensory hearing pes and insertion of an artificial stapes corrects
loss or deafness occurs when there is damage to the condition.
the inner ear or auditory nerve. This type of hear-
ing loss usually cannot be corrected, but cochlear
implants can improve severe hearing loss.
THE TONGUE AND
Ménière’s Disease SENSE OF TASTE
Ménière’s disease results from a collection of fluid
in the labyrinth of the inner ear and a degeneration The tongue is a mass of muscle tissue with pro-
of the hair cells in the cochlea and vestibule. Symp- jections called papillae (figure 7-38). The papillae
toms include severe vertigo (dizziness), tinnitus contain taste buds that are stimulated by the fla-
(ringing in the ears), nausea and vomiting, loss of vors of foods moistened by saliva. There are four
balance, and a tendency to fall. Forms of treatment main tastes: sweet tastes and salty tastes at the
include drugs to reduce the fluid, draining the fluid, tip of the tongue; sour tastes at the sides of the
and antihistamines. In severe, chronic cases, sur- tongue; and bitter tastes at the back of the tongue.
gery to destroy the cochlea may be performed; Taste is influenced by the sense of smell.
however, this causes permanent deafness.
Otitis Externa
Otitis externa is an inflammation of the external
THE NOSE AND SENSE
auditory canal. It is caused by a pathogenic organ- OF SMELL
ism such as a bacterium or virus. Swimmer’s ear
is one form. It is caused by swimming in contam- The nose is the organ of smell (figure 7-39). The
inated water. Inserting bobby pins, fingernails, or sense of smell is made possible by olfactory
cotton swabs into the ear can also cause this con- receptors, which are located in the upper part of
dition. Treatment methods include antibiotics; the nasal cavity. Impulses from these receptors
warm, moist compresses; and/or pain medica- are carried to the brain by the olfactory nerve.
tions. The human nose can detect more than 6,000 dif-
ferent smells. The sense of smell is more sensitive
Otitis Media than taste, but is closely related to the sense of
Otitis media is an inflammation or infection of the taste. This is clearly illustrated by the fact that
middle ear that is caused by a bacterium or virus. It food does not taste as good when you have a head
frequently follows a sore throat because organisms cold and your sense of smell is impaired.
from the throat can enter the middle ear through
the eustachian tube. Infants and young children
are very susceptible to otitis media because the THE SKIN AND
eustachian tube is angled differently than in adults.
Secretions from the nose and throat accumulate GENERAL SENSES
in the middle ear, resulting in an inflammatory
General sense receptors for pressure, heat, cold,
response that causes the eustachian tube to swell
touch, and pain are located throughout the body
shut. Symptoms include severe pain, fever, vertigo
in the skin and connective tissue. Each receptor
(dizziness), nausea and vomiting, and fluid buildup
perceives only one type of sense. For example,
in the middle ear. Treatment usually consists of
the skin contains special receptors for heat and
administering antibiotics and pain medications. At
different receptors for cold. Messages from these
times, a myringotomy (incision of the tympanic
receptors allow the human body to respond to its
membrane) is performed, and tubes are inserted
environment and help it react to conditions that
to relieve pressure and allow fluid to drain.
can cause injury.
Otosclerosis
Otosclerosis occurs when the stapes becomes STUDENT: Go to the workbook and complete
immobile, causing conductive hearing loss. the assignment sheet for 7:7, Special Senses.
182 CHAPTER 7
Quinine Circumvallate
papillae
Gustatory
Bitter (taste)
pores
Duct of
gland
Sour
Nerve
endings
Salt Sweet Schematic drawing of

section of tastebuds from
circumvallate papillae
FIGURE 7-38 Locations of taste buds.
Olfactory Olfactory Bulb of

cells nerve olfactory
nerve Olfactory
Glands center in
brain
Section of
olfactory
mucosa
FIGURE 7-39 The sense of smell.
♦ List the three major types of blood vessels and

7:8 Circulatory System the action of each type
Objectives ♦ Compare the three main types of blood cells
by describing the function of each
to: ♦ Describe at least five diseases of the circula-
tory system
♦ Label the layers, chambers, valves, and major
blood vessels on a diagram of the heart ♦ Define, pronounce, and spell all key terms
♦ Differentiate between systole and diastole by
explaining what happens in the heart during
each phase
KEY TERMS
aortic valve (ay-or!-tick) hemoglobin (hee!-mow- pulmonary valve
arrhythmias glow"-bin) right atrium
arteries left atrium (ay!-tree-um) right ventricle
blood left ventricle (ven!tri"-kul) septum
capillaries (cap!-ih-lair-eez) leukocytes (lew!-coh-sitez") systole (sis!-tah-lee")
circulatory system mitral valve (my!-tral) thrombocytes (throm!-bow-
diastole (dy-az!-tah-lee") myocardium sitez)
endocardium (en-doe-car!- pericardium tricuspid valve
dee-um) plasma (plaz!-ma) veins
erythrocytes (eh-rith!-row-
sitez)

◆ Cardiac Surgeon ◆ Electrocardiographic ◆ Perfusionist
◆ Cardiologist
Technician ◆ Phlebotomist
◆ Hematologist
◆ Cardiovascular ◆ Radiology Technologist
Technologist ◆ Internist
◆ Thoracic Surgeon
◆ Echocardiographer ◆ Medical Laboratory
Technologist/Technician
bon dioxide and metabolic materials away from

7:8 INFORMATION the body cells.
The circulatory system, also known as the car-
diovascular system, is often referred to as the
“transportation” system of the body. It consists of
THE HEART
the heart, blood vessels, and blood. It transports The heart is a muscular, hollow organ often called
oxygen and nutrients to the body cells, and car- the “pump” of the body (figure 7-40). Even though
184 CHAPTER 7
Superior vena cava Aorta

(from upper part of body)
Right pulmonary artery
Left pulmonary artery
Right pulmonary veins Left pulmonary veins
Pulmonary semilunar valve Left atrium
Aortic semilunar valve

Right atrium
Bicuspid (mitral) valve
Tricuspid valve
Left ventricle
Septum
Endocardium
Right ventricle
Myocardium
Pericardium
Inferior vena cava Apex
(from lower part of body)
FIGURE 7-40 Basic structure of the heart.
it weighs less than one pound and is approxi- tum is called the interatrial septum, and the lower
mately the size of a closed fist, it contracts about part is called the interventricular septum.
100,000 times each day to pump the equivalent of The heart is divided into four parts, or cham-
2,000 gallons of blood through the body. The bers. The two upper chambers are called atria,
heart is located in the mediastinal cavity, between and the two lower chambers are called ventricles.
the lungs, behind the sternum, and above the The right atrium receives blood as it returns
diaphragm. Three layers of tissue form the heart. from the body cells. The right ventricle receives
The endocardium is a smooth layer of cells that blood from the right atrium and pumps the blood
lines the inside of the heart and is continuous into the pulmonary artery, which carries the
with the inside of blood vessels. It allows for the blood to the lungs for oxygen. The left atrium
smooth flow of blood. The thickest layer is the receives oxygenated blood from the lungs. The
myocardium, the muscular middle layer. The left ventricle receives blood from the left atrium
pericardium is a double-layered membrane, or and pumps the blood into the aorta for transport
sac, that covers the outside of the heart. A lubri- to the body cells.
cating fluid, pericardial fluid, fills the space One-way valves in the chambers of the heart
between the two layers to prevent friction and keep the blood flowing in the right direction. The
damage to the membranes as the heart beats or tricuspid valve is located between the right
contracts. atrium and the right ventricle. It closes when the
The septum is a muscular wall that separates right ventricle contracts, allowing blood to flow to
the heart into a right side and a left side. It pre- the lungs and preventing blood from flowing back
vents blood from moving between the right and into the right atrium. The pulmonary valve is
left sides of the heart. The upper part of the sep- located between the right ventricle and the pul-
monary artery, a blood vessel that carries blood to of rest, called diastole, followed by a period of
the lungs. It closes when the right ventricle has ventricular contraction, called systole (figure
finished contracting, preventing blood from flow- 7-41). At the start of the cycle, the atria contract and
ing back into the right ventricle. The mitral valve push blood into the ventricles. The atria then relax,
is located between the left atrium and left ventri- and blood returning from the body enters the right
cle. It closes when the left ventricle is contracting, atrium, while blood returning from the lungs enters
allowing blood to flow into the aorta (for transport the left atrium. As the atria are filling, systole begins,
to the body) and preventing blood from flowing and the ventricles contract. The right ventricle
back into the left atrium. The aortic valve is pushes blood into the pulmonary artery, sending
located between the left ventricle and the aorta, the blood to the lungs for oxygen. The left ventricle
the largest artery in the body. It closes when the pushes blood into the aorta, sending the blood to
left ventricle is finished contracting, allowing all other parts of the body. The blood in the right
blood to flow into the aorta and preventing blood side of the heart is low in oxygen and high in car-
from flowing back into the left ventricle. bon dioxide. When this blood arrives in the lungs,
the carbon dioxide is released into the lungs, and
oxygen is taken into the blood. This oxygenated
Cardiac (Heartbeat) Cycle blood is then carried to the left side of the heart by
Although they are separated by the septum, the the pulmonary veins. This blood in the left side of
right and left sides of the heart work together in a the heart, high in oxygen and low in carbon diox-
cyclic manner. The cycle consists of a brief period ide, is ready for transport to the body cells.
Pulmonary circulation
Lungs Gas exchange occurs
at lung capillary beds
Blood to lungs Aorta
Blood from lungs Pulmonary artery
Superior vena cava Pulmonary veins
Pulmonary valve Left atrium
Right atrium Mitral valve
Inferior vena cava Aortic valve
Tricuspid valve Left ventricle
Right ventricle Endocardium
Pericardium Septum
Oxygen-poor blood Myocardium

Gas exchange occurs
Oxygen-rich blood at capillary beds of all
body tissues
Systemic circulation
FIGURE 7-41 The pattern of circulation in the cardiovascular system.
186 CHAPTER 7
Conductive Pathway mately every 0.8 seconds. The movement of the

Electrical impulses originating in the heart cause electrical impulse can be recorded on an electro-
the cyclic contraction of the muscles (figure cardiogram (ECG) and used to detect abnormal
7-42). A group of nerve cells located in the right activity or disease.
atrium and called the sinoatrial (SA) node, or the If something interferes with the normal elec-
“pacemaker,” sends out an electrical impulse that trical conduction pattern of the heart, arrhyth-
spreads out over the muscles in the atria. The mias occur. Arrhythmias are abnormal heart
atrial muscles then contract and push blood into rhythms and can be mild to life-threatening. For
the ventricles. After the electrical impulse passes example, an early contraction of the atria, or pre-
through the atria, it reaches the atrioventricular mature atrial contraction (PAC), can occur in
(AV) node, a group of nerve cells located between anyone and usually goes unnoticed. Ventricle
the atria and ventricles. The AV node sends the fibrillation, in which the ventricles contract at
electrical impulse through the bundle of His, random without coordination, decreases or elim-
nerve fibers in the septum. The bundle of His inates blood output and causes death if not
divides into a right bundle branch and a left bun- treated. Cardiac monitors and electrocardio-
dle branch, which carry the impulse down through grams are used to diagnose arrhythmias. Treat-
the ventricles. The bundle branches further sub- ment depends on the type and severity of the
divide into the Purkinje fibers, a network of nerve arrhythmia. Life-threatening fibrillations are
fibers throughout the ventricles. In this way, the treated with a defibrillator, a device that shocks
electrical impulse reaches all the muscle tissue in the heart with an electrical current to stop the
the ventricles, and the ventricles contract. This uncoordinated contraction and allow the SA node
electrical conduction pattern occurs approxi- to regain control.
Sinoatrial
(SA) node
(pacemaker)
Atrioventricular
bundle (bundle of His)
Atrioventricular
(AV) node
Purkinje fibers
Left and right bundle branches

FIGURE 7-42 Electrical conduction pathways in the heart.
At times it is necessary to use external or inter- Additional branches of the aorta carry blood to
nal artificial pacemakers to regulate the heart’s the head, neck, arms, chest, back, abdomen, and
rhythm, (figure 7-43). The pacemaker is a small, legs. The smallest branches of arteries are called
battery-powered device with electrodes. The elec- arterioles. They join with capillaries. Arteries are
trodes are threaded through a vein and positioned more muscular and elastic than are the other
in the right atrium and in the apex of the right ven- blood vessels because they receive the blood as it
tricle. The pacemaker monitors the heart’s activity is pumped from the heart.
and delivers an electrical impulse through the Capillaries connect arterioles with venules,
electrodes to stimulate contraction. Fixed pace- the smallest veins. Capillaries are located in close
makers deliver electrical impulses at a predeter- proximity to almost every cell in the body. They
mined rate. Demand pacemakers, the most have thin walls that contain only one layer of
common type, deliver electrical impulses only cells. These thin walls allow oxygen and nutrients
when the heart’s own conduction system is not to pass through to the cells and allow carbon
responding correctly. Even though modern pace- dioxide and metabolic products from the cells to
makers are protected from electromagnetic forces, enter the capillaries.
such as microwave ovens, most manufacturers Veins (figure 7-45) are blood vessels that
still recommend that people with pacemakers carry blood back to the heart. Venules, the small-
avoid close contact with digital cellular telephones. est branches of veins, connect with the capillar-
For example, the cellular telephone should not be ies. The venules join together and, becoming
stored in a shirt pocket close to the pacemaker. larger, form veins. The veins continue to join
together until they form the two largest veins: the
superior vena cava and the inferior vena cava.
BLOOD VESSELS The superior vena cava brings the blood from the
upper part of the body, and the inferior vena cava
When the blood leaves the heart, it is carried brings the blood from the lower part of the body.
throughout the body in blood vessels. The heart Both vena cavae drain into the right atrium of the
and blood vessels form a closed system for the heart. Veins are thinner and have less muscle tis-
flow of blood. There are three main types of blood sue than do arteries. Most veins contain valves,
vessels: arteries, capillaries, and veins. which keep the blood from flowing in a backward
Arteries (figure 7-44) carry blood away from direction (figure 7-46).
the heart. The aorta is the largest artery in the
body; it receives the blood from the left ventricle
of the heart. The aorta branches into all of the BLOOD COMPOSITION
other arteries that supply blood to the body. The
first branch of the aorta is the coronary artery, The blood that flows through the circulatory sys-
which divides into a right and left coronary artery tem is often called a tissue because it contains
to carry blood to the myocardium of the heart. many kinds of cells. There are approximately 4–6
quarts of blood in the average adult. This blood
Subclavian vein circulates continuously throughout the body. It
transports oxygen from the lungs to the body
Closed incision
site (covered cells, carbon dioxide from the body cells to the
with occlusive lungs, nutrients from the digestive tract to the
dressing) body cells, metabolic and waste products from
the body cells to the organs of excretion, heat
Subcutaneous produced by various body parts, and hormones
pocket
produced by endocrine glands to the body
Atrial lead
Pacemaker organs.
Superior vena cava
Right atrium Plasma

Right ventricle Ventricular lead Blood is made of the fluid called plasma and
FIGURE 7-43 Artificial pacemakers can help formed or solid elements called blood cells (figure
regulate the heart’s rhythm. 7-47). Plasma is approximately 90 percent water,
188 CHAPTER 7
Right internal carotid
Right external carotid
Left common carotid

Right common carotid
Left subclavian (to arms)

Brachiocephalic
Arch of aorta
Right subclavian
Left axillary
Left brachial
Hepatic
Aorta
Celiac trunk
Splenic
Superior mesenteric Gastric
Renal arteries Left renal (to kidney)

Left testicular/ovarian (gonadal)
Abdominal aorta
Inferior mesenteric
Right common iliac
Left radial
Left ulnar
Right digitals Left deep palmar arch
Left superficial
palmar arch
Right femoral
Left popliteal
Left anterior tibial
Left posterior tibial

Right peroneal
Left dorsalis pedis
Left dorsal arch
FIGURE 7-44 Major arteries of the body.
with many dissolved, or suspended, substances.

Among these substances are blood proteins such
Blood Cells
as fibrinogen and prothrombin (both necessary There are three main kinds of blood cells: eryth-
for clotting); nutrients such as vitamins, carbohy- rocytes, leukocytes, and thrombocytes.
drates, and proteins; mineral salts or electrolytes The erythrocytes, or red blood cells, are
such as potassium, calcium, and sodium; gases produced in the red bone marrow at a rate of
such as carbon dioxide and oxygen; metabolic about one million per minute. They live approxi-
and waste products; hormones; and enzymes. mately 120 days before being broken down by the
Superior sagittal sinus

Inferior sagittal sinus
Straight sinus
Right external jugular Left subclavian
Right internal jugular Great cardiac
Brachiocephalic Left cephalic

Superior vena cava Left axillary
Left basilic
Left brachial
Left hepatic
Right hepatic
Hepatic portal
Splenic
Inferior vena cava
Left renal
Superior mesenteric
Left ovarian or testicular
Right renal
Inferior mesenteric
Right ovarian
or testicular
Left external iliac
Right common iliac
Right palmar arch

Left palmar digitals
Right femoral
Right great saphenous
Left femoral
Left great saphenous
Left popliteal
Right small saphenous
Left posterior tibial
Left anterior tibial
Left dorsal venous arch
FIGURE 7-45 Major veins of the body.
liver and spleen. There are 4.5–5.5 million eryth- is bright red; when blood contains less oxygen
rocytes per cubic millimeter (approximately one and more carbon dioxide, it is a much darker red
drop) of blood, or approximately 25 trillion in the with a bluish cast.
body. The mature form circulating in the blood Leukocytes, or white blood cells, are not as
lacks a nucleus and is shaped like a disk with a numerous as are erythrocytes. They are formed
thinner central area. The erythrocytes contain in the bone marrow and lymph tissue and usually
hemoglobin, a complex protein composed of live about 3–9 days. A normal count is 5,000–9,000
the protein molecule called globin and the iron leukocytes per cubic millimeter of blood. Leuko-
compound called heme. Hemoglobin carries both cytes can pass through capillary walls and enter
oxygen and carbon dioxide. When carrying oxy- body tissue. Their main function is to fight infec-
gen, hemoglobin gives blood its characteristic tion. Some do this by engulfing, ingesting, and
red color. When blood contains a lot of oxygen, it destroying pathogens, or germs, by a process
190 CHAPTER 7
Blood flow toward called phagocytosis. The five types of leukocytes

the heart
and their functions include:
♦ Neutrophils: phagocytize bacteria by secreting
Valve open to an enzyme called lysozyme
allow for venous
blood flow ♦ Eosinophils: remove toxins and defend the
body from allergic reactions by producing
antihistamines
♦ Basophils: participate in the body’s inflamma-
tory response; produce histamine, a vasodila-
tor, and heparin, an anticoagulant
♦ Monocytes: phagocytize bacteria and foreign
materials
Valve closed to ♦ Lymphocytes: provide immunity for the body
prevent venous
back flow by developing antibodies; protect against the
formation of cancer cells
Thrombocytes, also called platelets, are
usually described as fragments or pieces of cells
because they lack nuclei and vary in shape and
size. They are formed in the bone marrow and
live for about 5–9 days. A normal thrombocyte
count is 250,000–400,000 per cubic millimeter of
blood. Thrombocytes are important for the clot-
FIGURE 7-46 Most veins contain valves to ting process, which stops bleeding. When a blood
prevent the backflow of blood.
Plasma
(55% of
Erythrocytes Thrombocytes
total
(platelets)
volume)
Formed
elements
Neutrophil Monocyte
(45% of
total
volume)
Leukocytes
Test tube Eosinophil Lymphocyte

containing
whole blood
Basophil
FIGURE 7-47 The major components of blood.
vessel is cut, the thrombocytes collect at the site ited anemia. It results in the production of abnor-
to form a sticky plug. They secrete a chemical, mal, crescent-shaped erythrocytes that carry less
serotonin, which causes the blood vessel to spasm oxygen, break easily, and block blood vessels (fig-
and narrow, decreasing the flow of blood. At the ure 7-48). Sickle cell anemia occurs almost exclu-
same time, the thrombocytes release an enzyme, sively among African Americans. Treatment
thromboplastin, which acts with calcium and methods include transfusions of packed cells and
other substances in the plasma to form throm- supportive therapy during crisis. Research
bin. Thrombin acts on the blood protein fibrino- directed toward bone marrow transplants, stem
gen to form fibrin, a gel-like net of fine fibers that cell transplants from placental blood, and gene
traps erythrocytes, platelets, and plasma to form cell therapy may offer a cure for sickle cell ane-
a clot. This is an effective method for controlling mia in the near future. Genetic counseling can
bleeding in smaller blood vessels. If a large blood lead to prevention of the disease if carriers make
vessel is cut, the rapid flow of blood can interfere informed decisions not to have children.
with the formation of fibrin. In these instances, a
doctor may have to insert sutures (stitches) to
close the opening and control the bleeding. Aneurysm
An aneurysm is a ballooning out of, or saclike for-
mation on, an artery wall. Disease, congenital
DISEASES AND defects, and injuries leading to weakened arterial
wall structure can cause this defect. Although some
ABNORMAL CONDITIONS aneurysms cause pain and pressure, others gener-
ate no symptoms. Common sites are the cerebral,
Anemia aortal, and abdominal arteries. If an aneurysm rup-
tures, hemorrhage, which can cause death, occurs.
Anemia is an inadequate number of red blood Treatment usually involves surgically removing the
cells, hemoglobin, or both. Symptoms include damaged area of blood vessel and replacing it with
pallor (paleness), fatigue, dyspnea (difficult a plastic graft or another blood vessel.
breathing), and rapid heart rate. Hemorrhage can
cause rapid blood loss, resulting in acute-blood-
loss anemia. Blood transfusions are used to cor- Arteriosclerosis
rect this form of anemia. Iron deficiency anemia
results when there is an inadequate amount of Arteriosclerosis is a hardening or thickening of
iron to form hemoglobin in erythrocytes. Iron the arterial walls, resulting in a loss of elasticity
supplements and increased iron intake in the diet and contractility. It commonly occurs as a result
from green leafy vegetables and other foods can of aging. Arteriosclerosis causes high blood pres-
correct this condition. Aplastic anemia is a result sure, or hypertension, and can lead to an aneu-
of injury to or destruction of the bone marrow, rysm or cerebral hemorrhage. The main focus of
leading to poor or no formation of red blood cells. treatment is lowering blood pressure through the
Common causes include chemotherapy, radia- use of diet, medications, or both.
tion, toxic chemicals, and viruses. Treatment
includes eliminating the cause, blood transfu-
sions, and in severe cases, a bone marrow trans-
plant. Unless the damage can be reversed, it is
frequently fatal. Pernicious anemia results in the
formation of erythrocytes that are abnormally
large in size, but inadequate in number. The
cause is a lack of intrinsic factor (a substance
normally present in the stomach), which results
Normal RBC
in inadequate absorption of vitamin B12. Vitamin
Sickled RBC
B12 and folic acid are required for the develop-
ment of mature erythrocytes. Administering vita-
min B12 injections can control and correct this FIGURE 7-48 Sickle cell anemia is characterized
condition. Sickle cell anemia is a chronic, inher- by abnormal, crescent-shaped erythrocytes.
192 CHAPTER 7
Atherosclerosis may involve either the right side or the left side of
the heart. Symptoms include edema (swelling);
Atherosclerosis occurs when fatty plaques (fre- dypsnea; pallor or cyanosis; distention of the
quently cholesterol) are deposited on the walls of neck veins; a weak, rapid pulse; and a cough
the arteries. This narrows the arterial opening, accompanied by pink, frothy sputum. Cardio-
which reduces or eliminates blood flow. If plaques tonic drugs (to slow and strengthen the heart-
break loose, they can circulate through the blood- beat), diuretics (to remove retained body fluids),
stream as emboli. A low-cholesterol diet, medica- elastic support hose, oxygen therapy, bedrest,
tions to lower cholesterol blood levels, abstaining and/or a low-sodium diet are used as treatment
from smoking, reduction of stress, and exercise methods.
are used to prevent atherosclerosis. Angioplasty
(figure 7-49) may be used to remove or compress
the deposits, or to insert a stent to allow blood
flow. Bypass surgery is used when the arteries are
completely blocked. Embolus
An embolus is a foreign substance circulating in
the bloodstream. It can be air, a blood clot, bacte-
Congestive Heart Failure rial clumps, a fat globule, or other similar sub-
Congestive heart failure (CHF) is a condition that stances. When an embolus enters an artery or
occurs when the heart muscles do not beat ade- capillary too small for passage, blockage of the
quately to supply the blood needs of the body. It blood vessel occurs.
(A) Conventional balloon angioplasty (B) Coronary atherectomy (C) Coronary stent
Atherectomy
Guidewire Balloon catheter Guiding Guidewire Deflated balloon device Stent Balloon
catheter
Cutter
1. In conventional balloon angioplasty, a 1. In coronary atherectomy procedures, a 1. To place a coronary stent within a vessel
guiding catheter is positioned in the opening of special cutting device with a deflated balloon narrowing, physicians use a special catheter
the coronary artery. The physician then pushes on one side and an opening on the other is with a deflated balloon and the stent at the tip.
a thin, flexible guidewire down the vessel and pushed over a wire down the coronary artery.
through the narrowing. The balloon catheter is
then advanced over this guidewire. Inflated balloon
2. The catheter is positioned so that the stent

is within the narrowed region of the coronary
2. When the device is within a coronary artery artery.
2. The balloon catheter is positioned next to the narrowing, the balloon is inflated, so that part
atherosclerotic plaque. of the atherosclerotic plaque is “squeezed”
into the opening of the device.
3. The balloon is then inflated, causing the

stent to expand and stretch the coronary
3. The balloon is inflated stretching and 3. When the physician starts rotating the artery.
cracking the plaque. cutting blade, pieces of plaque are shaved off
into the device.
4. The balloon catheter is then withdrawn,

4. When the balloon is withdrawn, blood flow is 4. The catheter is withdrawn, leaving a larger leaving the stent behind to keep the vessel
re-established through the widened vessel. opening for blood flow. open.
FIGURE 7-49 Ways to open clogged arteries: (A) balloon angioplasty, (B) coronary atherectomy, and (C)
coronary stent.
Hemophilia the arm, neck, and jaw; pressure in the chest; per-
spiration and cold, clammy skin; dypsnea; and a
Hemophilia is an inherited disease that occurs change in blood pressure. If the heart stops, car-
almost exclusively in male individuals but can be diopulmonary resuscitation should be started
carried by female individuals. Because of the lack immediately. Immediate treatment with a throm-
of a plasma protein required for the clotting pro- bolytic or “clot-busting” drug such as streptoki-
cess, the blood is unable to clot. A minor cut can nase or TPA, tissue plasminogen activator, may
lead to prolonged bleeding, and a minor bump open the blood vessel and restore blood flow to
can cause internal bleeding. Treatment involves the heart. However, the clot-busting drug must
transfusing whole blood, or plasma, and admin- be used within the first several hours, and its use
istering the missing protein factor. is prohibited if bleeding is present. Additional
treatment methods include complete bed rest,
pain medications, vasodilators, cardiotonic drugs
Hypertension (to slow and strengthen the heartbeat), oxygen
therapy, anticoagulants (to prevent additional
Hypertension is high blood pressure. A systolic
clots), and control of arrhythmias (abnormal
pressure above 140 and a diastolic pressure above
heart rhythms). Long-term care includes control
90 millimeters of mercury (mmHg) is usually
of blood pressure, a diet low in cholesterol and
regarded as hypertension. Risk factors that
saturated fat, avoidance of tobacco and stress,
increase the incidence of hypertension include
regular exercise, and weight control.
family history, race (higher in African Americans),
obesity, stress, smoking, aging (higher in post-
menopausal women), and a diet high in saturated
fat. Although there is no cure, hypertension can
Phlebitis
usually be controlled with antihypertensive Phlebitis is an inflammation of a vein, frequently
drugs, diuretics (to remove retained body fluids), in the leg. If a thrombus, or clot, forms, the condi-
limited stress, avoidance of tobacco, and/or a tion is termed thrombophlebitis. Symptoms
low-sodium or low-fat diet. If hypertension is not include pain, edema, redness, and discoloration
treated, it can cause permanent damage to the at the site. Treatment methods include anticoag-
heart, blood vessels, and kidneys. ulants; pain medication; elevation of the affected
area; antiembolism or support hose; and if nec-
essary, surgery to remove the clot.
Leukemia
Leukemia is a malignant disease of the bone mar- Varicose Veins
row or lymph tissue. It results in a high number of Varicose veins are dilated, swollen veins that have
immature white blood cells. There are different lost elasticity and cause stasis, or decreased blood
types of leukemia, some acute and some chronic. flow. They frequently occur in the legs and result
Symptoms include fever, pallor, swelling of lym- from pregnancy, prolonged sitting or standing,
phoid tissues, fatigue, anemia, bleeding gums, and hereditary factors. Treatment methods
excessive bruising, and joint pain. Treatment include exercise, antiembolism or support hose,
methods vary with the type of leukemia but can and avoidance of prolonged sitting or standing
include chemotherapy, radiation, and/or bone and tight-fitting or restrictive clothing. In severe
marrow transplant. cases, surgery can be performed to remove the
vein.
Myocardial Infarction STUDENT: Go to the workbook and complete

A myocardial infarction, or heart attack, occurs the assignment sheet for 7:8, Circulatory System.
when a blockage in the coronary arteries cuts off
the supply of blood to the heart. The affected
heart tissue dies and is known as an infarct. Death
can occur immediately. Symptoms include severe
crushing pain (angina pectoris) that radiates to
194 CHAPTER 7
7:9 Lymphatic System ♦ Identify the two lymphatic ducts and the areas
of the body that each drains
Objectives ♦ List at least three functions of the spleen
After completing this section, you should be able ♦ Describe the function of the thymus
to: ♦ Describe at least three diseases of the lym-
♦ Explain the function of lymphatic vessels phatic system
♦ List at least two functions of lymph nodes ♦ Define, pronounce, and spell all key terms
KEY TERMS
cisterna chyli (sis-tern!-uh- lymphatic capillaries (lim- spleen
kye!-lee) fat!-ik) thoracic duct (tho-rass!-ik)
lacteals lymphatic system thymus
lymph (limf !) lymphatic vessels tonsils
lymph nodes right lymphatic duct

◆ Immunologist ◆ Internist
7:9 INFORMATION tions of skeletal muscles against the lymph vessels

cause the lymph to flow through the vessels. Lym-
The lymphatic system consists of lymph, phatic vessels also have valves that keep the lymph
lymph vessels, lymph nodes, and lymphatic tis- flowing in only one direction. In the area of the
sue. This system works in conjunction with the small intestine, specialized lymphatic capillaries,
circulatory system to remove wastes and excess called lacteals, pick up digested fats or lipids.
fluids from the tissues (figure 7-50). When lymph is mixed with the lipids it is called
Lymph is a thin, watery fluid composed of chyle. The lacteals transport the chyle to the blood-
intercellular, or interstitial, fluid, which forms stream through the thoracic duct.
when plasma diffuses into tissue spaces. It is Lymph nodes, popularly called “glands,” are
composed of water, digested nutrients, salts, hor- located all over the body, usually in groups or
mones, oxygen, carbon dioxide, lymphocytes, clusters. They are small, round, or oval masses
and metabolic wastes such as urea. When this ranging in size from that of a pinhead to that of an
fluid enters the lymphatic system, it is known as almond. Lymph vessels bring lymph to the nodes.
lymph. The nodes filter the lymph and remove impurities
Lymphatic vessels are located throughout such as carbon, cancer cells, pathogens (disease-
the body in almost all of the tissues that have blood producing organisms), and dead blood cells. In
vessels. Small, open-ended lymph vessels act like addition, the lymphatic tissue in the nodes pro-
drainpipes and are called lymphatic capillar- duces lymphocytes (a type of leukocyte, or white
ies. The lymphatic capillaries pick up lymph at blood cell) and antibodies (substances used to
tissues throughout the body. The capillaries then combat infection). The purified lymph, with lym-
join together to form larger lymphatic vessels, phocytes and antibodies added, leaves the lymph
which pass through the lymph nodes. Contrac- node by a single lymphatic vessel.
Tissue
Lymphatic
cells
capillaries
From heart
An arteriole
Endothelial
cells
Blood capillaries
A venule
Lymph
High blood To heart

pressure pushing out
leaked capillary fluid
FIGURE 7-50 The lymphatic system works with the circulatory system to remove metabolic waste and
excess fluid from the tissues.
Deep cervical Submandibular
lymph nodes lymph node
As lymphatic vessels leave the lymph nodes,
Internal jugular
they continue to join together to form larger Right lymphatic vein
lymph vessels (figure 7-51). Eventually, these ves- duct
sels drain into one of two lymphatic ducts: the Left subclavian
right lymphatic duct or the thoracic duct. The vein
Right
right lymphatic duct is the short tube that subclavian
vein Axillary lymph
receives all of the purified lymph from the right node
side of the head and neck, the right chest, and the
right arm. It empties into the right subclavian
vein, returning the purified lymph to the blood. Thoracic
Intestinal duct *
The thoracic duct, a much larger tube, drains lymph
the lymph from the rest of the body. It empties nodes
into the left subclavian vein. At the start of the
Iliac nodes
thoracic duct, an enlarged pouchlike structure
called the cisterna chyli serves as a storage area
for purified lymph before this lymph returns to
the bloodstream. The cisterna chyli also receives
chyle from the intestinal lacteals.
In addition to being found in the lymph
nodes, lymphatic tissue is located throughout the
body. The tonsils, spleen, and thymus are exam-
ples of lymphatic tissue.
The tonsils are masses of lymphatic tissue
* Largest lymph
that filter interstitial fluid. There are three pairs of vessel in body
Inguinal lymph
tonsils: nodes
♦ Palatine tonsils: located on each side of the FIGURE 7-51 Main components of the lymphatic
soft palate system.
196 CHAPTER 7
♦ Pharyngeal tonsils: (also called adenoids) ritus (itching). Chemotherapy and radiation are
located in the nasopharynx (the upper part of usually effective forms of treatment.
the throat)
♦ Lingual tonsils: located on the back of the Lymphangitis
tongue
Lymphangitis is an inflammation of lymphatic
The spleen is an organ located beneath the vessels, usually resulting from an infection in an
left side of the diaphragm and in back of the extremity. Symptoms include a characteristic red
upper part of the stomach. It produces leukocytes streak extending up an arm or leg from the source
and antibodies, destroys old erythrocytes (red of infection, fever, chills, and tenderness or pain.
blood cells), stores erythrocytes to release into Treatment methods include antibiotics, rest, ele-
the bloodstream if excessive bleeding occurs, vation of the affected part, and/or warm, moist
destroys thrombocytes (platelets), and filters compresses.
metabolites and wastes from body tissues.
The thymus is a mass of lymph tissue located
in the center of the upper chest. It atrophies Splenomegaly
(wastes away) after puberty and is replaced by fat Splenomegaly is an enlargement of the spleen. It
and connective tissue. During early life, it pro- can result from an abnormal accumulation of red
duces antibodies and manufactures lymphocytes blood cells, mononucleosis, and cirrhosis of the
to fight infection. Its function is taken over by the liver. The main symptoms are swelling and
lymph nodes. abdominal pain. An increased destruction of
blood cells can lead to anemia (low red blood cell
count), leukopenia (low white blood cell count),
DISEASES AND and thrombocytopenia (low thrombocyte count).
If the spleen ruptures, intraperitoneal hemor-
ABNORMAL CONDITIONS rhage and shock can lead to death. In severe
cases, where the underlying cause cannot be
Adenitis treated, a splenectomy (surgical removal of the
spleen) is performed.
Adenitis is an inflammation or infection of the
lymph nodes. It occurs when large quantities of
harmful substances, such as pathogens or cancer
cells, enter the lymph nodes and infect the tissue.
Tonsillitis
Symptoms include fever and swollen, painful Tonsillitis is an inflammation or infection of the
nodes. If the infection is not treated, an abscess tonsils. It usually involves the pharyngeal (ade-
may form in the node. Usually treatment meth- noid) and palatine tonsils. Symptoms include
ods are antibiotics and warm, moist compresses. throat pain, dysphagia (difficulty swallowing),
If an abscess forms, it is sometimes necessary to fever, white or yellow spots of exudate on the ton-
incise and drain the node. sils, and swollen lymph nodes near the mandible.
Antibiotics, warm throat irrigations, rest, and
analgesics for pain are the main forms of treat-
ment. Chronic, frequent infections or hypertro-
Hodgkin’s Disease phy (enlargement) that causes obstruction are
Hodgkin’s disease is a chronic, malignant disease indications for a tonsillectomy, or surgical
of the lymph nodes. It is the most common form removal of the tonsils.
of lymphoma (tumor of lymph tissue). Symptoms
include painless swelling of the lymph nodes, STUDENT: Go to the workbook and complete
fever, night sweats, weight loss, fatigue, and pru- the assignment sheet for 7:9, Lymphatic System.
7:10 Respiratory System ♦ Describe the function of the epiglottis

♦ Compare the processes of inspiration and
Objectives expiration, including the muscle action that
After completing this section, you should be able occurs during each process
to: ♦ Differentiate between external and internal
♦ Label a diagram of the respiratory system respiration
♦ List five functions of the nasal cavity ♦ Describe at least five diseases of the respira-
tory system
♦ Identify the three sections of the pharynx
♦ Explain how the larynx helps create sound
and speech
KEY TERMS
alveoli (ahl-vee!-oh"-lie) inspiration pleura
bronchi (bron!-kie) internal respiration respiration
bronchioles (bron!-key"-ohlz) larynx (lar!-inks) respiratory system (res!-peh-
cellular respiration lungs reh-tor!-ee)
cilia (sil!-lee-ah) nasal cavities sinuses
epiglottis (ep-ih-glot!-tiss) nasal septum trachea (tray!-key"-ah)
expiration nose ventilation
external respiration pharynx (far!-inks)

◆ Internist ◆ Pulmonologist ◆ Respiratory Therapy
◆ Otolaryngologist ◆ Respiratory Therapist
Technician
◆ Thoracic Surgeon
◆ Perfusionist
7:10 INFORMATION RESPIRATORY ORGANS

The respiratory system consists of the lungs
and air passages. This system is responsible for
AND STRUCTURES
taking in oxygen, a gas needed by all body cells, The nose has two openings, called nostrils or
and removing carbon dioxide, a gas that is a met- nares, through which air enters. A wall of carti-
abolic waste product produced by the cells when lage, called the nasal septum, divides the nose
the cells convert food into energy. Because the into two hollow spaces, called nasal cavities.
body has only a 4–6-minute supply of oxygen, the The nasal cavities are lined with a mucous mem-
respiratory system must work continuously to brane and have a rich blood supply. As air enters
prevent death. the cavities, it is warmed, filtered, and moistened.
The parts of the respiratory system are the Mucus, produced by the mucous membranes,
nose, pharynx, larynx, trachea, bronchi, alveoli, moistens the air and helps trap pathogens and
and lungs (figure 7-52). dirt. Tiny, hairlike structures, called cilia, filter
198 CHAPTER 7
Sinuses
Nasal cavity
Nostril
Oral cavity
Tongue Pharynx
Epiglottis
Larynx (voice box) Esophagus
Right lung
Superior
(upper) lobe Trachea
Left lung
Visceral
Bronchial tree
pleura Left bronchus
Pleural cavity Bronchiole

Parietal pleura Alveoli
Middle lobe
Inferior (lower)
lobe
Diaphragm
Bronchiole
Esophagus
Mediastinum
Terminal
bronchiole
Alveolar duct
Capillaries
surrounding
alveoli
Alveolar
Alveoli
sac
FIGURE 7-52 The respiratory system.
inhaled air to trap dust and other particles. The sections. The nasopharynx is the upper portion,
cilia then help move the mucous layer that lines located behind the nasal cavities. The pharyngeal
the airways to push trapped particles toward the tonsils, or adenoids (lymphatic tissue), and the
esophagus, where they can be swallowed. The eustachian tube (tube to middle ear) openings
olfactory receptors for the sense of smell are also are located in this section. The oropharynx is the
located in the nose. The nasolacrimal ducts drain middle section, located behind the oral cavity
tears from the eye into the nose to provide addi- (mouth). This section receives both air from
tional moisture for the air. the nasopharynx and food and air from the
Sinuses are cavities in the skull that sur- mouth. The laryngopharynx is the bottom sec-
round the nasal area. They are connected to the tion of the pharynx. The esophagus, which car-
nasal cavity by short ducts. The sinuses are lined ries food to the stomach, and the trachea, which
with a mucous membrane that warms and moist- carries air to and from the lungs, branch off the
ens air. The sinuses also provide resonance for laryngopharynx.
the voice. The larynx, or voice box, lies between the
The pharynx, or throat, lies directly behind pharynx and trachea. It has nine layers of carti-
the nasal cavities. As air leaves the nose, it enters lage. The largest, the thyroid cartilage, is com-
the pharynx. The pharynx is divided into three monly called the Adam’s apple. The larynx
contains two folds, called vocal cords. The open-

ing between the vocal cords is called the glottis. PROCESS OF
As air leaves the lungs, the vocal cords vibrate
and produce sound. The tongue and lips act on
BREATHING
the sound to produce speech. The epiglottis, Ventilation is the process of breathing. It
a special leaflike piece of cartilage, closes the involves two phases: inspiration and expiration.
opening into the larynx during swallowing. This Inspiration (inhalation) is the process of breath-
prevents food and liquids from entering the respi- ing in air. The diaphragm (dome-shaped muscle
ratory tract. between the thoracic and abdominal cavities)
The trachea (windpipe) is a tube extending and the intercostal muscles (between the ribs)
from the larynx to the center of the chest. It car- contract and enlarge the thoracic cavity to create
ries air between the pharynx and the bronchi. A a vacuum. Air rushes in through the airways to
series of C-shaped cartilages (which are open on the alveoli, where the exchange of gases takes
the dorsal, or back, surfaces) help keep the tra- place. When the diaphragm and intercostal mus-
chea open. cles relax, the process of expiration (exhalation)
The trachea divides into two bronchi near occurs. Air is forced out of the lungs and air pas-
the center of the chest, a right bronchus and a left sages. This process of inspiration and expiration
bronchus. The right bronchus is shorter, wider, is known as respiration. The process of respira-
and extends more vertically than the left bron- tion is controlled by the respiratory center in the
chus. Each bronchus enters a lung and carries air medulla oblongata of the brain. An increased
from the trachea to the lung. In the lungs, the amount of carbon dioxide in the blood, or a
bronchi continue to divide into smaller and decreased amount of oxygen as seen in certain
smaller bronchi until, finally, they divide into diseases (asthma, congestive heart failure, or
the smallest branches, called bronchioles. The emphysema), causes the center to increase the
smallest bronchioles, called terminal bronchi- rate of respiration. Although this process is usu-
oles, end in air sacs, called alveoli. ally involuntary, a person can control the rate of
The alveoli resemble a bunch of grapes. An breathing by breathing faster or slower.
adult lung contains approximately 500 million
alveoli. They are made of one layer of squamous
epithelial tissue and contain a rich network of
blood capillaries. The capillaries allow oxygen STAGES OF
and carbon dioxide to be exchanged between the
blood and the lungs. The inner surfaces of the
RESPIRATION
alveoli are covered with a lipid (fatty) substance, There are two main stages of respiration: external
called surfactant, to help prevent them from col- respiration and internal respiration (figure 7-53).
lapsing. External respiration is the exchange of oxygen
The divisions of the bronchi and the alveoli and carbon dioxide between the lungs and blood-
are found in organs called lungs. The right lung stream. Oxygen, breathed in through the respira-
has three sections, or lobes: the superior, the tory system, enters the alveoli. Because the
middle, and the inferior. The left lung has only oxygen concentration in the alveoli is higher than
two lobes: the superior and the inferior. The left the oxygen concentration in the blood capillar-
lung is smaller because the heart is located toward ies, oxygen leaves the alveoli and enters the capil-
the left side of the chest. Each lung is enclosed in laries and the bloodstream. Carbon dioxide, a
a membrane, or sac, called the pleura. The metabolic waste product, is carried in the blood-
pleura consists of two layers of serous membrane: stream. Because the carbon dioxide concentra-
a visceral pleura attached to the surface of the tion in the capillaries is higher than the carbon
lung, and a parietal pleura attached to the chest dioxide concentration in the alveoli, carbon diox-
wall. A pleural space, located between the two ide leaves the capillaries and enters the alveoli,
layers, is filled with a thin layer of pleural fluid where it is expelled from the body during exhala-
that lubricates the membranes and prevents friction. Internal respiration is the exchange of
tion as the lungs expand during breathing. Both carbon dioxide and oxygen between the tissue
of the lungs, along with the heart and major blood cells and the bloodstream. Oxygen is carried to
vessels, are located in the thoracic cavity. the tissue cells by the blood. Because the oxygen
200 CHAPTER 7
Air sucked in Airways of respiratory

tree (ventilation)
Air blown out
Alveoli
O2
External respiration (gas exchange between air in

alveoli and blood in pulmonary capillaries)
CO2
Tissue cells
Blood in
pulmonary capillaries
Blood flow
CO2
O2
Internal
Blood in
respiration
systemic capillaries
(gas exchange
between tissue
Blood flow cells
and blood in
systemic
capillaries)
FIGURE 7-53 External and internal respiration.
concentration is higher in the blood than in the ertion, and infection can also cause an asthma
tissue cells, oxygen leaves the blood capillaries attack, during which bronchospasms narrow the
and enters the tissue cells. The cells then use the openings of the bronchioles, mucus production
oxygen and nutrients to produce energy, water, increases, and edema develops in the mucosal
and carbon dioxide. This process is called cellu- lining. Symptoms of an asthma attack include
lar respiration. Because the carbon dioxide dyspnea (difficult breathing), wheezing, cough-
concentration is higher in tissue cells than in the ing accompanied by expectoration of sputum,
bloodstream, carbon dioxide leaves the cells and and tightness in the chest. Treatment methods
enters the bloodstream to be transported back to include bronchodilators (to enlarge the bronchi-
the lungs, where external respiration takes place. oles), anti-inflammatory medications, epineph-
rine, and oxygen therapy. Identification and
elimination of or disensitization to allergens are
DISEASES AND important in preventing asthma attacks.
ABNORMAL CONDITIONS
Bronchitis
Asthma Bronchitis is an inflammation of the bronchi and
Asthma is a respiratory disorder usually caused bronchial tubes. Acute bronchitis is usually caused
by a sensitivity to an allergen such as dust, pollen, by infection and is characterized by a productive
an animal, medications, or a food. Stress, overex- cough, dyspnea, rales (bubbly or noisy breath
sounds), chest pain, and fever. It is treated with

antibiotics, expectorants (to remove excessive
mucus), rest, and drinking large amounts of water.
Chronic bronchitis results from frequent attacks of
acute bronchitis and long-term exposure to pollut-
ants or smoking. It is characterized by chronic
inflammation, damaged cilia, and enlarged mucous
glands. Symptoms include excessive mucus result-
ing in a productive cough, wheezing, dyspnea, chest
pain, and prolonged air expiration. Although there
is no cure, antibiotics, bronchodilators, and/or
respiratory therapy are used in treatment.
Chronic Obstructive
Pulmonary Disease
Chronic obstructive pulmonary disease (COPD) is
a term used to describe any chronic lung disease
that results in obstruction of the airways. Disorders
such as chronic asthma, chronic bronchitis, emphy-
sema, and tuberculosis lead to COPD. Smoking is
Images not available due to copyright restrictions
the primary cause, but allergies and chronic respi-
ratory infections are also factors. Treatment meth-
ods include bronchodilators, mucolytics (loosen
mucus secretions), and cough medications. The
prognosis is poor because damage to the lungs
causes a deterioration of pulmonary function, lead-
ing to respiratory failure and death.
Emphysema
Emphysema is a noninfectious, chronic respira-
tory condition that occurs when the walls of the
alveoli deteriorate and lose their elasticity (figure
7-54). Carbon dioxide remains trapped in the alve-
oli, and there is poor exchange of gases. The most
common causes are heavy smoking and prolonged
exposure to air pollutants. Symptoms include dys-
pnea, a feeling of suffocation, pain, barrel chest,
chronic cough, cyanosis, rapid respirations accom-
panied by prolonged expirations, and eventual
respiratory failure and death. Although there is no
cure, treatment methods include bronchodilators,
breathing exercises, prompt treatment of respira-
tory infections, oxygen therapy, respiratory ther-
apy, and avoidance of smoking. tension, chronic infection, anticoagulant drugs,
and blood diseases such as hemophilia and leu-
kemia. Compressing the nostrils toward the sep-
Epistaxis tum; elevating the head and tilting it slightly
Epistaxis, or a nosebleed, occurs when capillaries forward; and applying cold compresses will usu-
in the nose become congested and bleed. It can ally control epistaxis, although it is sometimes
be caused by an injury or blow to the nose, hyper- necessary to insert nasal packs or cauterize (burn
202 CHAPTER 7
and destroy) the bleeding vessels. Treatment of Pleurisy

any underlying cause, such as hypertension, is
important in preventing epistaxis. Pleurisy is an inflammation of the pleura, or
membranes, of the lungs. It usually occurs in
conjunction with pneumonia or other lung infec-
Influenza tions. Symptoms include sharp, stabbing pain
while breathing; crepitation (grating sounds in
Influenza, or flu, is a highly contagious viral infec- the lungs); dyspnea; and fever. Treatment meth-
tion of the upper respiratory system. Onset is ods include rest and medications to relieve pain
sudden, and symptoms include chills, fever, a and inflammation. If fluid collects in the pleural
cough, sore throat, runny nose, muscle pain, and space, a thoracentesis (withdrawal of fluid through
fatigue. Treatment methods include bed rest, flu- a needle) is performed to remove the fluid and
ids, analgesics (for pain), and antipyretics (for prevent compression of the lungs.
fever). Antibiotics are not effective against the
viruses that cause influenza, but they are some-
times given to prevent secondary infections such Pneumonia
as pneumonia. Immunization with a flu vaccine Pneumonia is an inflammation or infection of the
is recommended for the elderly, individuals with lungs characterized by exudate (a buildup of fluid)
chronic diseases, pregnant women, and health in the alveoli. It is usually caused by bacteria,
care workers. Because many different viruses viruses, protozoa, or chemicals. Symptoms include
cause influenza, vaccines are developed each chills, fever, chest pain, productive cough, dyspnea,
year to immunize against the most common and fatigue. Treatment methods include bed rest,
viruses identified. oxygen therapy, fluids, antibiotics (if indicated),
respiratory therapy, and/or pain medication.
Laryngitis
Laryngitis is an inflammation of the larynx and Rhinitis
vocal cords. It frequently occurs in conjunction Rhinitis is an inflammation of the nasal mucous
with other respiratory infections. Symptoms membrane, resulting in a runny nose, watery eyes,
include hoarseness or loss of voice, sore throat, sneezing, soreness, and congestion. Common
and dysphagia (difficult swallowing). Treatment causes are infections and allergens. Treatment con-
methods include rest, limited voice use, fluids, sists of administering fluids and medications to
and medication, if an infection is present. relieve congestion. Rhinitis is usually self-limiting.
Lung Cancer Sinusitis

Lung cancer is the leading cause of cancer death Sinusitis is an inflammation of the mucous mem-
in both men and women (figure 7-54). It is a brane lining the sinuses. One or more sinuses
preventable disease because the main cause is may be affected. Sinusitis is usually caused by a
exposure to carcinogens in tobacco, either bacterium or virus. Symptoms include headache
through smoking or through exposure to “sec- or pressure, dizziness, thick nasal discharge, con-
ond-hand” smoke. Three common types of lung gestion, and loss of voice resonance. Treatment
cancer include small cell, squamous cell, and methods include analgesics (for pain), antibiot-
adenocarcinoma. In the early stages, there are no ics (if indicated), decongestants (medications to
symptoms. In later stages, symptoms include a loosen secretions), and moist inhalations. Sur-
chronic cough, hemoptysis (coughing up blood- gery is used in cases of chronic sinusitis to open
tinged sputum), dyspnea, fatigue, weight loss, the cavities and encourage drainage.
and chest pain. The prognosis (outcome) for lung
cancer patients is poor because the disease is
usually advanced before it is diagnosed. Treat-
Sleep Apnea
ment includes surgical removal of the cancerous Sleep apnea is a condition in which an individ-
sections of the lung, radiation, and/or chemo- ual stops breathing while asleep, causing a mea-
therapy. surable decrease in blood oxygen levels. There
are two main kinds of sleep apnea: obstructive

and central. Obstructive sleep apnea is caused by
a blockage in the air passage that occurs when
the muscles that keep the airway open relax and
allow the tongue and palate to block the airway.
Central sleep apnea is caused by a disorder in
the respiratory control center of the brain. The
condition is more common in men. Factors such
as obesity, hypertension, smoking, alcohol
ingestion, and/or the use of sedatives may
increase the severity. Sleep apnea is diagnosed
when more than 5 periods of apnea lasting at
least 10 seconds each occur during 1 hour of
sleep. The periods of apnea reduce the blood FIGURE 7-55 The continuous positive airway
oxygen level. This causes the brain to awaken pressure (CPAP) mask attaches to a blower device
the individual, who then gasps for air and snores that uses air pressure to keep the airway open and
loudly. This interruption of the sleep cycle leads prevent sleep apnea.
to excessive tiredness and drowsiness during the
day. Treatment involves losing weight, abstain-
ing from smoking and the use of alcohol or sed- Upper Respiratory Infection
atives, and sleeping on the side or stomach. In
An upper respiratory infection (URI), or common
more severe cases of obstructive sleep apnea, a
cold, is an inflammation of the mucous mem-
continuous positive airway pressure, or CPAP
brane lining the upper respiratory tract. Caused
(pronounced see-pap), is used to deliver pres-
by viruses, URIs are highly contagious. Symptoms
sure to the airway to keep the airway open while
include fever, runny nose, watery eyes, conges-
the individual sleeps (figure 7-55). The CPAP
tion, sore throat, and hacking cough. There is no
consists of a mask that is fit securely against the
cure, and symptoms usually last approximately
face. Tubing connects the mask with a blower
one week. Analgesics (for pain), antipyretics (for
device that can be adjusted to deliver air at dif-
fever), rest, increased fluid intake, and antihista-
ferent levels of pressure. Treatment of central
mines (to relieve congestion) are used to treat the
sleep apnea usually involves the use of medica-
symptoms.
tions to stimulate breathing.
the assignment sheet for 7:10, Respiratory System.
Tuberculosis
Tuberculosis (TB) is an infectious lung disease 7:11 Digestive System
caused by the bacterium Mycobacterium tuber-
culosis. At times, white blood cells surround the Objectives
invading TB organisms and wall them off, creat- After completing this section, you should be able
ing nodules, called tubercles, in the lungs. The TB to:
organisms remain dormant in the tubercles but
can cause an active case of TB later, if body resis- ♦ Label the major organs on a diagram of the
tance is lowered. Symptoms of an active case of digestive system
TB include fatigue, fever, night sweats, weight ♦ Identify at least three organs that are located
loss, hemoptysis (coughing up blood-tinged spu- in the mouth and aid in the initial breakdown
tum), and chest pain. Treatment includes admin- of food
istering drugs for one or more years to destroy ♦ Cite two functions of the salivary glands
the bacteria. Good nutrition and rest are also
important. In recent years, a new strain of the TB ♦ Describe how the gastric juices act on food in
bacteria resistant to drug therapy has created the stomach
concern that TB will become a widespread infec- ♦ Explain how food is absorbed into the body by
tious disease. the villi in the small intestine
204 CHAPTER 7
♦ List at least three functions of the large intes- ♦ Describe at least five diseases of the digestive
tine system
♦ List at least four functions of the liver ♦ Define, pronounce, and spell all key terms
♦ Explain how the pancreas helps digest foods
KEY TERMS
alimentary canal (ahl-ih- hard palate rectum
men!-tar"-ee) ileum (ill!-ee"-um) salivary glands
anus jejunum (jeh-jew!-num) small intestine
colon (coh!-lun) large intestine soft palate
digestive system liver stomach
duodenum (dew-oh-deh!- mouth teeth
num) pancreas (pan!-cree"-as) tongue
esophagus (ee"-sof!-eh-gus) peristalsis (pair"-ih-stall"-sis) vermiform appendix
gallbladder pharynx (far!-inks) villi (vil!-lie)

◆ Dental Assistant ◆ Dietitian ◆ Hepatologist
◆ Dental Hygienist ◆ Enterostomal RN or ◆ Internist
◆ Dentist
Technician ◆ Proctologist
◆ Gastroenterologist
◆ Dietetic Assistant
7:11 INFORMATION PARTS OF THE

The digestive system, also known as the gastro-
ALIMENTARY CANAL
intestinal system, is responsible for the physical The mouth, also called the buccal cavity (figure
and chemical breakdown of food so that it can be 7-57) receives food as it enters the body. While
taken into the bloodstream and used by body food is in the mouth, it is tasted, broken down
cells and tissues. The system consists of the physically by the teeth, lubricated and partially
alimentary canal and accessory organs (figure digested by saliva, and swallowed. The teeth are
7-56). The alimentary canal is a long, muscular special structures in the mouth that physically
tube that begins at the mouth and includes the break down food by chewing and grinding. This
mouth (oral cavity), pharynx, esophagus, stom- process is called mastication. The tongue is a
ach, small intestine, large intestine, and anus. muscular organ that contains special receptors
The accessory organs are the salivary glands, called taste buds. The taste buds allow a person to
tongue, teeth, liver, gallbladder, and pancreas. taste sweet, salty, sour, and bitter sensations. The
Oral cavity
Parotid gland
Lips
Teeth Pharynx
Submandibular
Tongue gland
Sublingual gland
Esophagus
Diaphragm Stomach
Hepatic duct
Liver
Pylorus of the
Cystic duct stomach
Gallbladder Pancreas
Transverse colon
of large intestine
Duodenum
Jejunum of
Ascending colon of large intestine small intestine
Descending
colon of large
Ileum of small intestine intestine
Sigmoid colon
of large intestine
Cecum
Rectum
Vermiform appendix
Anus
FIGURE 7-56 The digestive system.
tongue also aids in chewing and swallowing food. down of carbohydrates, or starches, into sugars
The hard palate is the bony structure that forms that can be taken into the body.
the roof of the mouth and separates the mouth After the food is chewed and mixed with
from the nasal cavities. Behind the hard palate is saliva, it is called a bolus. When the bolus is swal-
the soft palate, which separates the mouth from lowed, it enters the pharynx (throat). The phar-
the nasopharynx. The uvula, a cone-shaped ynx is a tube that carries both air and food. It
muscular structure, hangs from the middle of the carries the air to the trachea, or windpipe, and
soft palate. It prevents food from entering the food to the esophagus. When a bolus is being
nasopharynx during swallowing. Three pairs of swallowed, muscle action causes the epiglottis to
salivary glands, the parotid, sublingual, and close over the larynx, preventing the bolus from
submandibular, produce a liquid called saliva. entering the respiratory tract and causing it to
Saliva lubricates the mouth during speech and enter the esophagus.
chewing and moistens food so that it can be swal- The esophagus is the muscular tube dorsal
lowed easily. Saliva also contains an enzyme (a to (behind) the trachea. This tube receives the
substance that speeds up a chemical reaction) bolus from the pharynx and carries the bolus to
called salivary amylase, formerly known as ptya- the stomach. The esophagus, like the remaining
lin. Salivary amylase begins the chemical break- part of the alimentary canal, relies on a rhythmic,
206 CHAPTER 7
mentary canal. It is approximately 20 feet in

Gum (gingiva) Upper lip length and 1 inch in diameter, and is divided into
three sections: the duodenum, the jejunum, and
the ileum. The duodenum is the first 9–10 inches
Labial frenulum
of the small intestine. Bile (from the gallbladder
Hard
and liver) and pancreatic juice (from the pan-
palate creas) enter this section through ducts, or tubes.
Palatine tonsil
The jejunum is approximately 8 feet in length
Soft and forms the middle section of the small intes-
palate tine. The ileum is the final 12 feet of the small
intestine, and it connects with the large intestine
Uvula
at the cecum. The circular muscle called the ileo-
Lingual frenulum
cecal valve separates the ileum and cecum and
Tongue prevents food from returning to the ileum. While
food is in the small intestine, the process of diges-
Teeth tion is completed, and the products of digestion
Gum (gingiva) are absorbed into the bloodstream for use by the
body cells. Intestinal juices, produced by the
Lower lip Labial frenulum small intestine, contain the enzymes maltase,
sucrase, and lactase, which break down sugars
FIGURE 7-57 Parts of the oral cavity, or mouth. into simpler forms. The intestinal juices also con-
tain enzymes known as peptidases, which com-
wavelike, involuntary movement of its muscles plete the digestion of proteins, and steapsin
called peristalsis to move the food in a forward (lipase), which aids in the digestion of fat. Bile
direction. from the liver and gallbladder emulsifies (physi-
The stomach is an enlarged part of the ali- cally breaks down) fats. Enzymes from the pan-
mentary canal. It receives the food from the creatic juice complete the process of digestion.
esophagus. The mucous membrane lining of the These enzymes include pancreatic amylase or
stomach contains folds, called rugae. These dis- amylopsin (which acts on sugars), trypsin and
appear as the stomach fills with food and expands. chymotrypsin (which act on proteins), and lipase
The cardiac sphincter, a circular muscle between or steapsin (which acts on fats). After food has
the esophagus and stomach, closes after food been digested, it is absorbed into the blood-
enters the stomach and prevents food from going stream. The walls of the small intestine are lined
back up into the esophagus. The pyloric sphinc- with fingerlike projections called villi (figure
ter, a circular muscle between the stomach and 7-58). The villi contain blood capillaries and lac-
small intestine, keeps food in the stomach until teals. The blood capillaries absorb the digested
the food is ready to enter the small intestine. Food nutrients and carry them to the liver, where they
usually remains in the stomach for approximately are either stored or released into general circula-
2–4 hours. During this time, food is converted tion for use by the body cells. The lacteals absorb
into a semifluid material, called chyme, by gastric most of the digested fats and carry them to the
juices produced by glands in the stomach. The thoracic duct in the lymphatic system, which
gastric juices contain hydrochloric acid and releases them into the circulatory system. When
enzymes. Hydrochloric acid kills bacteria, facili- food has completed its passage through the small
tates iron absorption, and activates the enzyme intestine, only wastes, indigestible materials, and
pepsin. The enzymes in gastric juices include excess water remain.
lipase, which starts the chemical breakdown of The large intestine is the final section of
fats, and pepsin, which starts protein digestion. the alimentary canal. It is approximately 5 feet in
In infants, the enzyme rennin is also secreted to length and 2 inches in diameter. Functions
aid in the digestion of milk. Rennin is not present include absorption of water and any remaining
in adults. nutrients; storage of indigestible materials before
When the food, in the form of chyme, leaves they are eliminated from the body; synthesis (for-
the stomach, it enters the small intestine. The mation) and absorption of some B-complex vita-
small intestine is a coiled section of the ali- mins and vitamin K by bacteria present in the
Capillary network
in villus
Lacteal
Epithelial
cells
Intestinal
gland
Artery
Vein
Lymph
vessel
Circular
muscles
Longitudinal
muscles
Peritoneum
FIGURE 7-58 Lymphatic and blood capillaries in the villi of the small intestine provide for the absorption of
the products of digestion.
intestine; and transportation of waste products Left lobe of liver
out of the alimentary canal. The large intestine is
divided into a series of connected sections. The Right hepatic
cecum is the first section and is connected to the duct
ileum of the small intestine. It contains a small Cystic
projection, called the vermiform appendix. duct
The next section, the colon, has several divi- Left hepatic duct
sions. The ascending colon continues up on the
Common hepatic duct
right side of the body from the cecum to the lower Gallbladder
part of the liver. The transverse colon extends
across the abdomen, below the liver and stomach Tail of
and above the small intestine. The descending pancreas
colon extends down the left side of the body. It
connects with the sigmoid colon, an S-shaped Common bile duct
section that joins with the rectum. The rectum is Main pancreatic
the final 6–8 inches of the large intestine and is a Head of
duct
pancreas
storage area for indigestibles and wastes. It has a
narrow canal, called the anal canal, which opens
Duodenum
at a hole, called the anus. Fecal material, or stool, Sphincter
the final waste product of the digestive process, is of Oddi
expelled through this opening. FIGURE 7-59 The liver, gallbladder, and
pancreas.
ACCESSORY ORGANS soluble, which is necessary for absorption. The

liver stores sugar in the form of glycogen. The gly-
The liver (figure 7-59), is the largest gland in the cogen is converted to glucose and released into
body and is an accessory organ to the digestive the bloodstream when additional blood sugar is
system. It is located under the diaphragm and in needed. The liver also stores iron and certain
the upper right quadrant of the abdomen. The vitamins. It produces heparin, which prevents
liver secretes bile, which is used to emulsify fats clotting of the blood; blood proteins such as
in the digestive tract. Bile also makes fats water fibrinogen and prothrombin, which aid in clot-
208 CHAPTER 7
ting of the blood; and cholesterol. Finally, the pain that starts under the rib cage and radiates to
liver detoxifies (renders less harmful) substances the right shoulder. If a gallstone blocks the bile
such as alcohol and pesticides, and destroys bac- ducts, the gallbladder can rupture and cause
teria that have been taken into the blood from peritonitis. Treatment methods include a low-fat
the intestine. diet, lithotripsy (shock waves that are used to
The gallbladder is a small, muscular sac shatter the gallstones), and/or a cholecystectomy
located under the liver and attached to it by con- (surgical removal of the gallbladder).
nective tissue. It stores and concentrates bile,
which it receives from the liver. When the bile is
needed to emulsify fats in the digestive tract, the Cirrhosis
gallbladder contracts and pushes the bile through Cirrhosis is a chronic destruction of liver cells
the cystic duct into the common bile duct, which accompanied by the formation of fibrous connec-
drains into the duodenum. tive and scar tissue. Causes include hepatitis, bile
The pancreas is a glandular organ located duct disease, chemical toxins, and malnutrition
behind the stomach. It produces pancreatic associated with alcoholism. Symptoms vary and
juices, which contain enzymes to digest food. become more severe as the disease progresses.
These juices enter the duodenum through the Some common symptoms are liver enlargement,
pancreatic duct. The enzymes in the juices anemia, indigestion, nausea, edema in the legs
include pancreatic amylase or amylopsin (to and feet, hematemesis (vomiting blood), nose-
break down sugars), trypsin and chymotrypsin bleeds, jaundice (yellow discoloration), and asci-
(to break down proteins), and lipase or steapsin tes (an accumulation of fluid in the abdominal
(to act on fats). The pancreas also produces insu- peritoneal cavity). When the liver fails, disorienta-
lin, which is secreted into the bloodstream. Insu- tion, hallucinations, hepatic coma, and death
lin regulates the metabolism, or burning, of occur. Treatment is directed toward preventing
carbohydrates to convert glucose (blood sugar) further damage to the liver. Alcohol avoidance,
to energy. proper nutrition, vitamin supplements, diuretics
(to reduce ascites and edema), rest, infection pre-
vention, and appropriate exercise are encouraged.
DISEASES AND A liver transplant may be performed if too much of
the liver is destroyed.
ABNORMAL CONDITIONS
Appendicitis Constipation
Appendicitis is an acute inflammation of the Constipation is when fecal material remains in the
appendix, usually resulting from an obstruction colon too long, causing excessive reabsorption of
and infection. Symptoms include generalized water. The feces or stool becomes hard, dry, and
abdominal pain that later localizes at the lower difficult to eliminate. Causes include poor bowel
right quadrant, nausea and vomiting, mild fever, habits, chronic laxative use leading to a “lazy”
and elevated white blood cell count. If the appen- bowel, a diet low in fiber, and certain digestive dis-
dix ruptures, the infectious material will spill into eases. The condition is usually corrected by a high-
the peritoneal cavity and cause peritonitis, a seri- fiber diet, adequate fluids, and exercise. Although
ous condition. Appendicitis is treated by an appen- laxatives are sometimes used to stimulate defeca-
dectomy (surgical removal of the appendix). tion, frequent laxative use may be habit forming
and lead to chronic constipation.
Cholecystitis
Cholecystitis is an inflammation of the gallblad-
Diarrhea
der. When gallstones form from crystallized cho- Diarrhea is a condition characterized by frequent
lesterol, bile salts, and bile pigments, the watery stools. Causes include infection, stress,
condition is known as cholelithiasis. Symptoms diet, an irritated colon, and toxic substances.
frequently occur after eating fatty foods and Diarrhea can be extremely dangerous in infants
include indigestion, nausea and vomiting, and and small children because of the excessive fluid
loss. Treatment is directed toward eliminating the taminated by the feces of an infected person. It is
cause, providing adequate fluid intake, and mod- the most benign form of hepatitis and is usually
ifying the diet. self-limiting. A vaccine is available to prevent
hepatitis A. Type B, HBV, or serum hepatitis, is
transmitted by body fluids including blood,
Diverticulitis serum, saliva, urine, semen, vaginal secretions,
Diverticulitis is an inflammation of the diverticula, and breast milk. It is more serious than type A
pouches (or sacs) that form in the intestine as the and can lead to chronic hepatitis or to cirrhosis of
mucosal lining pushes through the surrounding the liver. A vaccine developed to prevent hepati-
muscle. When fecal material and bacteria become tis B is recommended for all health care workers.
trapped in the diverticula, inflammation occurs. Type C, or HCV, is also spread through contact
This can result in an abscess or rupture, leading to with blood or body fluids. The main methods of
peritonitis. Symptoms vary depending on the transmission include sharing needles while
amount of inflammation but may include abdom- injecting drugs, getting stuck with a contami-
inal pain, irregular bowel movements, flatus (gas), nated needle or sharps while on the job, or pass-
constipation or diarrhea, abdominal distention ing the virus from an infected mother to the infant
(swelling), low-grade fever, and nausea and vomit- during birth. Hepatitis C is much more likely to
ing. Treatment methods include antibiotics, stool- progress to chronic hepatitis, cirrhosis, or both.
softening medications, pain medications, high- There is no vaccine for type C. Other strains of the
fiber diet, and in severe cases, surgery to remove hepatitis virus that have been identified include
the affected section of colon. types D and E. Symptoms include fever, anorexia
(lack of appetite), nausea, vomiting, fatigue, dark-
colored urine, clay-colored stool, myalgia (mus-
Gastroenteritis cle pain), enlarged liver, and jaundice. Treatment
methods include rest and a diet high in protein
Gastroenteritis is an inflammation of the mucous
and calories and low in fat. A liver transplant may
membrane that lines the stomach and intestinal
be necessary if the liver is severely damaged.
tract. Causes include food poisoning, infection, and
toxins. Symptoms include abdominal cramping,
nausea, vomiting, fever, and diarrhea. Usual treat-
ment methods are rest and increased fluid intake.
Hernia
In severe cases, antibiotics, intravenous fluids, and A hernia, or rupture, occurs when an internal
medications to slow peristalsis may be used. organ pushes through a weakened area or natural
opening in a body wall. A hiatal hernia is when
the stomach protrudes through the diaphragm
Hemorrhoids and into the chest cavity through the opening for
Hemorrhoids are painful dilated or varicose veins the esophagus (figure 7-60). Symptoms include
of the rectum and/or anus. They may be caused heartburn, stomach distention, chest pain, and
by straining to defecate, constipation, pressure difficult swallowing. Treatment methods include
during pregnancy, insufficient fluid intake, laxa- a bland diet, small frequent meals, staying upright
tive abuse, and prolonged sitting or standing. after eating, and surgical repair. An inguinal her-
Symptoms include pain, itching, and bleeding. nia is when a section of the small intestine pro-
Treatment methods include a high-fiber diet; trudes through the inguinal rings of the lower
increased fluid intake; stool softeners; sitz baths abdominal wall. If the hernia cannot be reduced
or warm, moist compresses; and in some cases, a (pushed back in place), a herniorrhaphy (surgical
hemorrhoidectomy (surgical removal of the hem- repair) is performed.
orrhoids).
Pancreatitis
Hepatitis Pancreatitis is an inflammation of the pancreas.
Hepatitis is a viral inflammation of the liver. Type The pancreatic enzymes begin to digest the pan-
A, HAV or infectious hepatitis, is highly conta- creas itself, and the pancreas becomes necrotic,
gious and is transmitted in food or water con- inflamed, and edematous. If the damage extends
210 CHAPTER 7
Esophagus This part of the

stomach is normally
Ulcer
located below the An ulcer is an open sore on the lining of the diges-
diaphragm.
Cardiac tive tract. Peptic ulcers include gastric (stomach)
sphincter ulcers and duodenal ulcers. The major cause is a
bacterium, Helicobacter pylori (H. pylori), that
burrows into the stomach membranes, allowing
Diaphragm
stomach acids and digestive juices to create an
ulcer. Symptoms include burning pain, indiges-
Stomach
tion, hematemesis (bloody vomitus), and melena
(dark, tarry stool). Usual treatment methods are
antacids, a bland diet, decreased stress, and
Pyloric avoidance of irritants such as alcohol, fried foods,
sphincter tobacco, and caffeine. If the H. pylori bacteria are
present, treatment with antibiotics and a bismuth
preparation, such as Pepto-Bismol, usually cures
the condition. In severe cases, surgery is per-
formed to remove the affected area.
FIGURE 7-60 A hiatal hernia occurs when the Ulcerative Colitis

stomach protrudes through the diaphragm.
Ulcerative colitis is a severe inflammation of the
colon accompanied by the formation of ulcers
and abscesses. It is thought to be caused by stress,
food allergy, or an autoimmune reaction. The
main symptom is diarrhea containing blood, pus,
to blood vessels in the pancreas, hemorrhage and and mucus. Other symptoms include weight loss,
shock occur. Pancreatitis may be caused by exces- weakness, abdominal pain, anemia, and anorexia.
sive alcohol consumption or blockage of pancre- Periods of remission and exacerbation are com-
atic ducts by gallstones. Many cases are idiopathic, mon. Treatment is directed toward controlling
or of unknown cause. Symptoms include severe inflammation, reducing stress with mild seda-
abdominal pain that radiates to the back, nausea, tion, maintaining proper nutrition, and avoiding
vomiting, diaphoresis (excessive perspiration), substances that aggravate the condition. In some
and jaundice if swelling blocks the common bile cases, surgical removal of the affected colon and
duct. Treatment depends on the cause. A chole- creation of a colostomy (an artificial opening in
cystectomy, removal of the gall bladder, is per- the colon that allows fecal material to be excreted
formed if gallstones are the cause. Analgesics for through the abdominal wall) is necessary.
pain and nutritional support are used if the cause
of pancreatitis is alcoholism or idiopathic. This STUDENT: Go to the workbook and complete
type of pancreatitis has a poor prognosis and the assignment sheet for 7:11, Digestive System.
often results in death.
Peritonitis 7:12 Urinary System

Peritonitis, an inflammation of the abdominal
peritoneal cavity, usually occurs when a rupture Objectives
in the intestine allows the intestine contents to After completing this section, you should be able
enter the peritoneal cavity. A ruptured appendix to:
or gallbladder can cause this condition. Symp-
toms include abdominal pain and distention, ♦ Label a diagram of the urinary system
fever, nausea, and vomiting. Treatment methods ♦ Explain the action of the following parts of a
include antibiotics and, if necessary, surgical nephron: glomerulus, Bowman’s capsule, con-
repair of the damaged intestine. voluted tubule, and collecting tubule
♦ State the functions of the ureter, bladder, and ♦ Describe at least three diseases of the urinary
urethra system
♦ Explain why the urethra is different in male ♦ Define, pronounce, and spell all key terms
and female individuals
♦ Interpret at least five terms used to describe
conditions that affect urination
KEY TERMS
bladder hilum urethra (you"-wreath!-rah)
Bowman’s capsule homeostasis urinary meatus (you!-rih-
cortex (core!-tex) kidneys nah-ree" me-ate!-as)
excretory system (ex!-kreh- medulla (meh-due!-la) urinary system
tor"-ee) nephrons (nef!-ronz) urine
glomerulus (glow"-mare!- renal pelvis void
you-luss) ureters (you!-reh"-turz)

◆ Dialysis Technician ◆ Medical Laboratory ◆ Nephrologist
Technologist/Technician ◆ Urologist
7:12 INFORMATION Connective tissue helps hold the kidneys in posi-

tion. Each kidney is enclosed in a mass of fatty
The urinary system, also known as the excre- tissue, called an adipose capsule, and covered
tory system, is responsible for removing certain externally by a tough, fibrous tissue, called the
wastes and excess water from the body and for renal fascia, or fibrous capsule.
maintaining the body’s acid–base balance. It is Each kidney is divided into two main sec-
one of the major body systems that maintains tions: the cortex and the medulla. The cortex is
homeostasis, a state of equilibrium or constant the outer section of the kidney. It contains most
state of natural balance in the internal environ- of the nephrons, which aid in the production of
ment of the body. The parts of the urinary system urine. The medulla is the inner section of the
are two kidneys, two ureters, one bladder, and kidney. It contains most of the collecting tubules,
one urethra (figure 7-61). which carry the urine from the nephrons through
The kidneys (figure 7-62) are two bean- the kidney. Each kidney has a hilum, a notched
shaped organs located on either side of the verte- or indented area through which the ureter, nerves,
bral column, behind the upper part of the blood vessels, and lymph vessels enter and leave
abdominal cavity, and separated from this cavity the kidney.
by the peritoneum. Their location is often Nephrons (figure 7-63) are microscopic fil-
described as retroperitoneal. The kidneys are tering units located in the kidneys. There are
protected by the ribs and a heavy cushion of fat. more than one million nephrons per kidney. Each
212 CHAPTER 7
Adrenal Renal cortex

(suprarenal) glands (contains most of
each nephron)
Renal medulla
Renal capsule
Left renal artery
Renal pelvis Left kidney
Inferior vena cava Abdominal aorta
Right and left

ureters
Ureteral orifices
Urinary bladder
(urocyst)
Urethra
External urethral
orifice (urinary
meatus)
FIGURE 7-61 The urinary system.
nephron consists of a glomerulus, a Bowman’s them into the convoluted tubule. As these mate-
capsule, a proximal convoluted tubule, a distal rials pass through the various sections of the
convoluted tubule, and a collecting duct (tubule). tubule, substances needed by the body are reab-
The renal artery carries blood to the kidney. sorbed and returned to the blood capillaries. By
Branches of the renal artery pass through the the time the filtered materials pass through the
medulla to the cortex, where the blood enters the tubule, most of the water, glucose, vitamins, and
first part of the nephron, the glomerulus, which mineral salts have been reabsorbed. Excess glu-
is a cluster of capillaries. As blood passes through cose and mineral salts, some water, and wastes
the glomerulus, water, mineral salts, glucose (including urea, uric acid, and creatinine) remain
(sugar), metabolic products, and other sub- in the tubule and become known as the concen-
stances are filtered out of the blood. Red blood trated liquid called urine. The urine then enters
cells and proteins are not filtered out. The filtered collecting ducts, or tubules, located in the
blood leaves the glomerulus and eventually medulla. These collecting ducts empty into the
makes its way to the renal vein, which carries it renal pelvis (renal basin), a funnel-shaped
away from the kidney. The substances filtered out structure that is the first section of the ureter.
in the glomerulus enter the next section of the The ureters are two muscular tubes approx-
nephron, the Bowman’s capsule. The Bow- imately 10–12 inches in length. One extends from
man’s capsule is a C-shaped structure that sur- the renal pelvis of each kidney to the bladder.
rounds the glomerulus and is the start of the Peristalsis (a rhythmic, wavelike motion of mus-
convoluted tubule. It picks up the materials fil- cle) moves the urine through the ureter from the
tered from the blood in the glomerulus and passes kidney to the bladder.
3.75 cm (1.5 inches) in length that opens in front

of the vagina and carries only urine to the out-
Renal side. In males, the urethra is approximately 20 cm
pyramid (8 inches) in length and passes through the pros-
tate gland and out through the penis. It carries
Renal
both urine (from the urinary system) and semen
papilla
(from the reproductive system), although not at
Hilum the same time.
Urine is the liquid waste product produced
Renal by the urinary system. It is approximately 95 per-
artery cent water. Waste products dissolved in this liq-
uid are urea, uric acid, creatinine, mineral salts,
Renal and various pigments. Excess useful products,
vein such as sugar, can also be found in the urine, but
their presence usually indicates disease. Approxi-
Renal mately 1,500–2,000 milliliters (mL) (1.5–2 quarts)
pelvis of urine are produced daily from the approxi-
mately 150 quarts of liquid that is filtered through
Ureter the kidneys.
Terms used to describe conditions that affect
urination include:
Cortex ♦ Polyuria: excessive urination
♦ Oliguria: below normal amounts of urination
Medulla ♦ Anuria: absence of urination
FIGURE 7-62 A cross section of the kidney. ♦ Hematuria: blood in the urine
♦ Pyuria: pus in the urine
♦ Nocturia: urination at night
The bladder is a hollow, muscular sac that ♦ Dysuria: painful urination
lies behind the symphysis pubis and at the mid-
line of the pelvic cavity. It has a mucous mem-
♦ Retention: inability to empty the bladder
brane lining arranged in a series of folds, called ♦ Incontinence: involuntary urination
rugae. The rugae disappear as the bladder ♦ Proteinuria: protein in the urine
expands to fill with urine. Three layers of visceral
(smooth) muscle form the walls of the bladder,
♦ Albuminuria: albumin (a blood protein) in the
urine
which receives the urine from the ureters and
stores the urine until it is eliminated from the
body. Although the urge to void (urinate, or mic-
turate) occurs when the bladder contains approx-
imately 250 milliliters (mL) (1 cup) of urine, the DISEASES AND
bladder can hold much more. A circular sphinc-
ter muscle controls the opening to the bladder to
ABNORMAL CONDITIONS
prevent emptying. When the bladder is full,
receptors in the bladder wall send out a reflex
Cystitis
action, which opens the muscle. Infants cannot Cystitis is an inflammation of the bladder, usually
control this reflex action. As children age, how- caused by pathogens entering the urinary meatus.
ever, they learn to control the reflex. It is more common in female individuals because
The urethra is the tube that carries the urine of the shortness of the urethra. Symptoms include
from the bladder to the outside. The external frequent urination, dysuria, a burning sensation
opening is called the urinary meatus. The ure- during urination, hematuria, lower back pain,
thra is different in female individuals and male bladder spasm, and fever. Treatment methods are
individual. In females, it is a tube approximately antibiotics and increased fluid intake.
214 CHAPTER 7
Bowman's
(glomerular) capsule
Proximal convoluted tubule
Distal convoluted tubule
Glomerulus
Efferent
arteriole
Cortex
From Medulla
Afferent
kidney
arteriole
artery
Collecting
tubule
Loop of Henle
Capillary net
To kidney vein
Henle's loop
FIGURE 7-63 A nephron unit.
Glomerulonephritis appetite), weight loss, congestive heart failure,

pyuria, and finally, renal failure and death occur.
Glomerulonephritis, or nephritis, is an inflam- Treatment is directed at treating the symptoms,
mation of the glomerulus of the kidney. Acute and treatment methods include a low-sodium
glomerulonephritis usually follows a streptococ- diet, antihypertensive drugs, maintenance of flu-
cal infection such as strep throat, scarlet fever, or ids and electrolytes, and hemodialysis (removal
rheumatic fever. Symptoms include chills, fever, of the waste products from the blood by a hemo-
fatigue, edema, oliguria, hematuria, and albu- dialysis machine) (figure 7-64). When both kid-
minuria (protein in the urine). Treatment meth- neys are severely damaged, a kidney transplant
ods include rest, restriction of salt, maintenance can be performed.
of fluid and electrolyte balance, antipyretics (for
fever), diuretics (for edema), and at times, antibi-
otics. With treatment, kidney function is usually
restored, and the prognosis is good. Repeated
Pyelonephritis
attacks can cause a chronic condition. Chronic Pyelonephritis is an inflammation of the kidney
glomerulonephritis is a progressive disease that tissue and renal pelvis (upper end of the ureter),
causes scarring and sclerosing of the glomeruli. usually caused by pyogenic (pus-forming) bacte-
Early symptoms include hematuria, albuminuria, ria. Symptoms include chills, fever, back pain,
and hypertension. As the disease progresses and fatigue, dysuria, hematuria, and pyuria (pus in
additional glomeruli are destroyed, edema, the urine). Treatment methods are antibiotics
fatigue, anemia, hypertension, anorexia (loss of and increased fluid intake.
Renal Failure
Renal failure is when the kidneys stop function-
ing. Acute renal failure (ARF) can be caused by
hemorrhage, shock, injury, poisoning, nephritis,
or dehydration. Symptoms include oliguria or
anuria, headache, an ammonia odor to the
breath, edema, cardiac arrhythmia, and uremia.
Prompt treatment involving dialysis, restricted
fluid intake, and correction of the condition caus-
ing renal failure results in a good prognosis.
Chronic renal failure (CRF) results from the pro-
gressive loss of kidney function. It can be caused
by chronic glomerulonephritis, hypertension,
toxins, and endocrine disease such as diabetes
mellitus. Long-term substance abuse and alco-
holism can also lead to renal failure. Waste prod-
ucts accumulate in the blood and affect many
body systems. Symptoms include nausea, vomit-
ing, diarrhea, weight loss, decreased mental abil-
ity, convulsions, muscle irritability, an ammonia
odor to the breath, uremic frost (deposits of white
crystals on the skin), and in later stages, coma
prior to death. Treatment methods are dialysis,
diet modifications and restrictions, careful skin
and mouth care, and control of fluid intake. A
kidney transplant is the only cure.
FIGURE 7-64 A hemodialysis machine helps

remove waste products from the blood when the
Uremia
kidneys are not functioning correctly. Uremia, also called azotemia, is a toxic condition
that occurs when the kidneys fail and urinary
waste products are present in the bloodstream. It
can result from any condition that affects the
Renal Calculus proper functioning of the kidneys, such as renal
failure, chronic glomerulonephritis, and hypo-
A renal calculus, or urinary calculus, is a kidney tension. Symptoms include headache, dizziness,
stone. A calculus is formed when salts in the urine nausea, vomiting, an ammonia odor to the breath,
precipitate (settle out of solution). Some small oliguria or anuria, mental confusion, convul-
calculi may be eliminated in the urine, but larger sions, coma, and eventually, death. Treatment
stones often become lodged in the renal pelvis or consists of a restricted diet, cardiac medications
ureter. Symptoms include sudden, intense pain to increase blood pressure and cardiac output,
(renal colic); hematuria; nausea and vomiting; a and dialysis until a kidney transplant can be per-
frequent urge to void; and in some cases, urinary formed.
retention. Initial treatment consists of increasing
fluids, providing pain medication, and straining
all urine through gauze or filter paper to deter-
mine whether stones are being eliminated. Extra- Urethritis
corporeal shock-wave lithotripsy is a procedure Urethritis is an inflammation of the urethra, usu-
where high-energy pressure waves are used to ally caused by bacteria (such as gonococcus),
crush the stones so that they can be eliminated viruses, or chemicals (such as bubble bath solu-
through the urine. In some cases, surgery is tions). It is more common in male than female
required to remove the calculi. individuals. Symptoms include frequent and
216 CHAPTER 7
painful urination, redness and itching at the uri-

nary meatus, and a purulent (pus) discharge. 7:13 Endocrine System
Treatment methods include sitz baths or warm,
moist compresses; antibiotics; and/or increased
Objectives
fluid intake. After completing this section, you should be able
to:
STUDENT: Go to the workbook and complete ♦ Label a diagram of the main endocrine
the assignment sheet for 7:12, Urinary System. glands
♦ Describe how hormones influence various
body functions
♦ Describe at least five diseases of the endocrine
glands
KEY TERMS
adrenal glands (ah"-dree!- pancreas (pan-kree-as) placenta
nal) parathyroid glands testes (tess!-tees)
endocrine system (en!-doh"- pineal body (pin!-knee"-ahl) thymus
krin) pituitary gland (pih"-too!-ih- thyroid gland
hormones tar-ee)
ovaries

◆ Endocrinologist ◆ Nuclear Medicine
Technologist
7:13 INFORMATION ♦ Stimulate other endocrine glands
The endocrine system consists of a group of ♦ Regulate growth and development

ductless (without tubes) glands that secrete sub- ♦ Regulate metabolism
stances directly into the bloodstream. These sub- ♦ Maintain fluid and chemical balance
stances are called hormones. The endocrine
system consists of the pituitary gland, thyroid
♦ Control various sex processes
gland, parathyroid gland, adrenal glands, pan- Table 7-3 lists the main hormones produced
creas, ovaries, testes, thymus, pineal body, and by each endocrine gland and the actions they
placenta (figure 7-65). perform.
Hormones, chemical substances produced
and secreted by the endocrine glands, are fre-
quently called “chemical messengers.” They are
transported throughout the body by the blood- PITUITARY GLAND
stream and perform many functions including: The pituitary gland is often called the “master
♦ Stimulate exocrine glands (glands with ducts, gland” of the body because it produces many
or tubes) to produce secretions hormones that affect other glands. It is located at
Pineal
Pituitary
Thyroid
Thymus
Parathyroid
glands
Posterior view
Cortex Pancreas
(Islets of Langerhans)
Medulla
Adrenal
Testis Ovary
FIGURE 7-65 The endocrine system.
TABLE 7-3 Hormones Produced by the Endocrine Glands and Their Actions
GLAND HORMONE ACTION
Pituitary
Anterior lobe ACTH—adrenocorticotropic Stimulates growth and secretion of the cortex of the adrenal gland
TSH—thyrotropin Stimulates growth and secretion of the thyroid gland
GH—somatotropin Growth hormone, stimulates normal body growth
FSH—follicle stimulating Stimulates growth and hormone production in the ovarian follicles
of female individuals, production of sperm in male individuals
LH—luteinizing (female) Causes ovulation and secretion of progesterone in female individuals
or
ICSH—interstitial cell Stimulates testes to secrete testosterone
stimulating (male)
LTH—lactogenic or prolactin Stimulates secretion of milk from mammary glands after delivery
of an infant
MSH—melanocyte stimulating Stimulates production and dispersion of melanin pigment in the
skin
(continues)
218 CHAPTER 7
TABLE 7-3 Hormones Produced by the Endocrine Glands and Their Actions (Continued)
Posterior lobe ADH—vasopressin Antidiuretic hormone, promotes reabsorption of water in kidneys,

constricts blood vessels
Oxytocin (pitocin) Causes contraction of uterus during childbirth, stimulates milk flow
from the breasts
Thyroid
Thyroxine and tri-iodothyronine Increase metabolic rate; stimulate physical and mental growth;
regulate metabolism of carbohydrates, fats, and proteins
Thyrocalcitonin (calcitonin) Accelerates absorption of calcium by the bones and lowers blood
calcium level
Parathyroid
Parathormone (PTH) Regulates amount of calcium and phosphate in the blood,
increases reabsorption of calcium and phosphates from bones,
stimulates kidneys to conserve blood calcium, stimulates
absorption of calcium in the intestine
Adrenal
Cortex Mineralocorticoids Regulate the reabsorption of sodium in the kidney and the elimina-
Aldosterone tion of potassium, increase the reabsorption of water by the
kidneys
Glucocorticoids Aid in metabolism of proteins, fats, and carbohydrates; increase
Cortisol-hydrocortisone amount of glucose in blood; provide resistance to stress; and
Cortisone depress immune responses (anti-inflammatory)
Gonadocorticoids Act as sex hormones
Estrogens Stimulate female sexual characteristics
Androgens Stimulate male sexual characteristics
Medulla Epinephrine (adrenaline) Activates sympathetic nervous system, acts in times of stress to
increase cardiac output and increase blood pressure
Norepinephrine Activates body in stress situations
Pancreas
Insulin Used in metabolism of glucose (sugar) by promoting entry of
glucose into cells to decrease blood glucose levels, promotes
transport of fatty acids and amino acids (proteins) into the cells
Glucagon Maintains blood level of glucose by stimulating the liver to release
stored glycogen in the form of glucose
Ovaries
Estrogen Promotes growth and development of sex organs in female
individuals
Progesterone Maintains lining of uterus
Testes
Testosterone Stimulates growth and development of sex organs in male
individuals, stimulates maturation of sperm
Thymus
Thymosin (thymopoietin) Stimulates production of lymphocytes and antibodies in early life
(continues)
TABLE 7-3 Hormones Produced by the Endocrine Glands and Their Actions (Continued)
Pineal
Melatonin May delay puberty by inhibiting gonadotropic (sex) hormones, may
regulate sleep/wake cycles
Adrenoglomerulotropin May stimulate adrenal cortex to secrete aldosterone
Serotonin May prevent vasoconstriction of blood vessels in the brain, inhibits
gastric secretions
Placenta
Estrogen Stimulates growth of reproductive organs
Chorionic gonadotropin Causes corpus luteum of ovary to continue secretions
Progesterone Maintains lining of uterus to provide fetal nutrition
the base of the brain in the sella turcica, a small,

bony depression of the sphenoid bone. It is
divided into two sections, or lobes: the anterior
lobe and the posterior lobe. Each lobe secretes
certain hormones, as shown in table 7-3.
Diseases and
Abnormal Conditions
Acromegaly
Acromegaly results from an oversecretion of
somatotropin (growth hormone) in an adult and
is usually caused by a benign (noncancerous)
tumor of the pituitary called an adenoma. Bones
of the hands, feet, and face enlarge and create a
grotesque appearance. The skin and tongue
thicken, and slurred speech develops. Surgical
removal and/or radiation of the tumor is the FIGURE 7-66 Giantism results when the pituitary
usual treatment, but the tumor frequently recurs. gland secretes excessive amounts of somatotropin
Acromegaly eventually causes cardiovascular and (growth hormone) before puberty.
respiratory diseases that shorten life expectancy.
include polyuria (excessive urination), polydipsia
Giantism (excessive thirst), dehydration, weakness, consti-
Giantism results from an oversecretion of somato- pation, and dry skin. The condition is corrected
tropin before puberty (figure 7-66). It causes by administering ADH.
excessive growth of long bones, extreme tallness,
decreased sexual development, and at times, Dwarfism
retarded mental development. If a tumor of the Dwarfism results from an undersecretion of
pituitary is the cause, surgical removal or radia- somatotropin and can be caused by a tumor,
tion is the treatment. infection, genetic factors, or injury (figure 7-67).
It is characterized by small body size, short
Diabetes Insipidus extremities, and lack of sexual development.
Diabetes insipidus is caused by decreased secre- Mental development is usually normal. If the
tion of vasopressin, or antidiuretic hormone condition is diagnosed early, it can be treated
(ADH). A low level of ADH prevents water from with injections of somatotropic hormone for 5 or
being reabsorbed in the kidneys. Symptoms more years until long bone growth is complete.
220 CHAPTER 7
polydipsia (excessive thirst), goiter formation, and

hypertension. An excessive appetite with extreme
weight loss is a classic symptom. Treatment con-
sists of either radiation to destroy part of the thy-
roid or a thyroidectomy (surgical removal of the
thyroid). If the thyroid is removed, thyroid hor-
mones are given for the lifetime of the individual.
Graves’ Disease
Graves’ disease is a severe form of hyperthyroid-
ism more common in women than men.
Symptoms include a strained and tense facial
FIGURE 7-67 Dwarfism results from an underse- expression, exophthalmia (protruding eyeballs),
cretion of somatotropin (growth hormone). goiter, nervous irritability, emotional instability,
tachycardia, a tremendous appetite accompa-
nied by weight loss, and diarrhea. Treatment
THYROID GLAND methods include medication to inhibit the syn-
thesis of thyroxine, radioactive iodine to destroy
The thyroid gland synthesizes hormones that thyroid tissue, and/or a thyroidectomy.
regulate the body’s metabolism and control the
level of calcium in the blood. It is located in front Hypothyroidism
of the upper part of the trachea (windpipe) in the Hypothyroidism is an underactivity of the thyroid
neck. It has two lobes, one on either side of the gland and a deficiency of thyroid hormones. Two
larynx (voice box), connected by the isthmus, a main forms exist: cretinism and myxedema. Cre-
small piece of tissue. To produce its hormones, tinism develops in infancy or early childhood and
the thyroid gland requires iodine, which is results in a lack of mental and physical growth,
obtained from certain foods and iodized salt. The leading to mental retardation and an abnormal,
hormones secreted by the thyroid gland are dwarfed stature. If diagnosed early, oral thyroid
shown in table 7-3. hormone can be given to minimize mental and
physical damage. Myxedema occurs in later child-
hood or adulthood. Symptoms include coarse, dry
Diseases and skin; slow mental function; fatigue; weakness;
intolerance of cold; weight gain; edema; puffy
Abnormal Conditions eyes; and a slow pulse. Treatment consists of
Goiter administering oral thyroid hormone to restore
A goiter is an enlargement of the thyroid gland. normal metabolism. In some countries where
Causes can include a hyperactive thyroid, an iodized salt is not available, myxedema may be
iodine deficiency, an oversecretion of thyroid- caused by an iodine deficiency. Adding iodine to
stimulating hormone on the part of the pituitary the diet corrects this type of myxedema.
gland, or a tumor. Symptoms include thyroid
enlargement, dysphagia (difficult swallowing), a
cough, and a choking sensation. Treatment is
directed toward eliminating the cause. For exam-
PARATHYROID GLANDS
ple, iodine is given if a deficiency exists. Surgery The parathyroid glands are four small glands
may be performed to remove very large goiters. located behind and attached to the thyroid gland.
Their hormone, parathormone, regulates the
Hyperthyroidism amount of calcium in the blood (see table 7-3). It
Hyperthyroidism is an overactivity of the thyroid stimulates bone cells to break down bone tissue
gland, which causes increased production of thy- and release calcium and phosphates into the
roid hormones and increased basal metabolic rate blood, causes the kidneys to conserve and reab-
(BMR). Symptoms include extreme nervousness, sorb calcium, and activates intestinal cells to
tremors, irritability, rapid pulse, diarrhea, diapho- absorb calcium from digested foods. Although
resis (excessive perspiration), heat intolerance, most of the body’s calcium is in the bones, the
calcium circulating in the blood is important for groups: mineralocorticoids, glucocorticoids, and
blood clotting, the tone of heart muscle, and gonadocorticoids. The groups and the main hor-
muscle contraction. Because there is a constant mones in each group are listed in table 7-3. The
exchange of calcium and phosphate between the adrenal medulla secretes two main hormones:
bones and blood, the parathyroid hormone plays epinephrine and norepinephrine. These hor-
an important function in maintaining the proper mones are sympathomimetic; that is, they mimic
level of circulating calcium. the sympathetic nervous system and cause the
fight or flight response.
Diseases and Abnormal

Diseases and Abnormal
Conditions
Hyperparathyroidism
Conditions
Hyperparathyroidism is an overactivity of the Addison’s Disease
parathyroid gland resulting in an overproduc- Addison’s disease is caused by decreased secre-
tion of parathormone. This results in hypercalce- tion of aldosterone on the part of the adrenal cor-
mia (increased calcium in the blood), which leads tex. This interferes with the reabsorption of
to renal calculi (kidney stones) formation, leth- sodium and water and causes an increased level
argy, gastrointestinal disturbances, and calcium of potassium in the blood. Symptoms include
deposits on the walls of blood vessels and organs. dehydration, diarrhea, fatigue, hypotension (low
Because the calcium is drawn from the bones, blood pressure), mental lethargy, weight loss,
they become weak, deformed, and likely to frac- muscle weakness, excessive pigmentation lead-
ture. This condition is often caused by an ade- ing to a “bronzing” (yellow-brown color) of the
noma (glandular tumor), and removal of the skin, hypoglycemia (low blood sugar), and edema.
tumor usually results in normal parathyroid func- Treatment methods include administering corti-
tion. Other treatments include surgical removal costeroid hormones, controlled intake of sodium,
of the parathyroids followed by administration of and fluid regulation to combat dehydration.
parathormone, diuretics to increase the excretion
of water and calcium, and a low-calcium diet. Cushing’s Syndrome
Cushing’s syndrome results from an oversecre-
Hypoparathyroidism tion of glucocorticoids on the part of the adrenal
Hypoparathyroidism is an underactivity of the cortex. It can be caused by either a tumor of the
parathyroid gland, which causes a low level of adrenal cortex or excess production of ACTH on
calcium in the blood. Causes include the surgical the part of the pituitary gland. Symptoms include
removal of or injury to the parathyroid and/or hyperglycemia (high blood sugar), hypertension,
thyroid glands. Symptoms include tetany (a sus- muscle weakness, fatigue, hirsutism (excessive
tained muscular contraction), hyperirritability of growth and/or an abnormal distribution of hair),
the nervous system, and convulsive twitching. poor wound healing, a tendency to bruise easily,
Death can occur if the larynx and respiratory a “moon” face, and obesity (figure 7-68). If a tumor
muscles are involved. The condition is easily is causing the disease, treatment is removal of the
treated with calcium, vitamin D (which increases tumor. If the glands are removed, hormonal ther-
the absorption of calcium from the digestive apy is required to replace the missing hormones.
tract), and parathormone. Cushing’s syndrome can also occur in patients
receiving long-term steroid therapy such as pred-
nisone. These patients must be monitored closely,
and steroid therapy must be reduced gradually if
ADRENAL GLANDS symptoms of Cushing’s syndrome develop.
The adrenal glands are frequently called the
suprarenal glands because one is located above
each kidney. Each gland has two parts: the outer
PANCREAS
portion, or cortex, and the inner portion, or The pancreas is a fish-shaped organ located
medulla. The adrenal cortex secretes many ste- behind the stomach. It is both an exocrine gland
roid hormones, which are classified into three and an endocrine gland. As an exocrine gland, it
222 CHAPTER 7
FIGURE 7-68 Cushing’s syndrome. (A) The classic “moon face” of Cushing’s syndrome. (B) The same
individual after treatment. (Courtesy of Ruth Jones)
secretes pancreatic juices, which are carried to controlled with diet and/or oral hypoglycemic
the small intestine by the pancreatic duct to aid (lower-blood-sugar) medications. The main
in the digestion of food. Special B, or beta, cells symptoms include hyperglycemia (high blood
located throughout the pancreas in patches of sugar), polyuria (excessive urination), polydipsia
tissue called islets of Langerhans produce the (excessive thirst), polyphagia (excessive hunger),
hormone insulin, which is needed for the cells to glycosuria (sugar in the urine), weight loss,
absorb sugar from the blood. Insulin also pro- fatigue, slow healing of skin infections, and vision
motes the transport of fatty acids and amino changes. If the condition is not treated, diabetic
acids (proteins) into the cells. Alpha, or A, cells coma and death may occur. Treatment methods
produce the hormone glucagon, which increases are a carefully regulated diet to control the blood
the glucose level in blood (see table 7-3). sugar level, regulated exercise, and oral hypogly-
cemic drugs or insulin injections. Newer medica-
tions that increase insulin production, increase
Disease the sensitivity to insulin, or slow the absorption
Diabetes Mellitus of glucose into cells are also available. External
Diabetes mellitus is a chronic disease caused by and implantable insulin pumps that monitor
decreased secretion of insulin. The metabolism blood glucose levels and deliver the required
of carbohydrates, proteins, and fats is affected. amount of insulin can be used to replace insulin
There are two main types of diabetes mellitus, injections. A new form of therapy is an inhaled
named according to the age of onset and need for form of insulin. However, this is expensive and
insulin. Insulin-dependent diabetes mellitus has not been approved for use in children.
(IDDM), or Type 1, usually occurs early in life, is Estimates indicate that more than 16 million
more severe, and requires insulin. Noninsulin- Americans have diabetes, and as many as 40–50
dependent diabetes mellitus (NIDDM), or Type 2, percent might not know they have the disease.
is the mature-onset form of diabetes mellitus. It Researchers have proved that weight control
frequently occurs in obese adults and is usually (avoiding obesity) and moderate exercise can
reduce the risk for development of diabetes by as The thymus is a mass of tissue located in the
much as 55–70 percent. Preventing diabetes is upper part of the chest and under the sternum. It
important because diabetes can cause athero- contains lymphoid tissue. The thymus is active in
sclerosis, myocardial infarctions (heart attacks), early life, activating cells in the immune system,
cerebrovascular accidents (strokes), peripheral but atrophies (wastes away) during puberty,
vascular disease leading to poor wound healing when it becomes a small mass of connective tis-
and gangrene in the legs and feet, diabetic reti- sue and fat. It produces one hormone, thymosin
nopathy causing blindness, and kidney disease (see table 7-3).
or failure. The pineal body is a small structure attached
to the roof of the third ventricle in the brain.
Knowledge regarding the physiology of this gland
OTHER ENDOCRINE is limited. Three main hormones secreted by this
gland are listed in table 7-3.
GLANDS The placenta is a temporary endocrine
The ovaries are the gonads, or sex glands, of the gland produced during pregnancy. It acts as a link
female. They are located in the pelvic cavity, one between the mother and infant, provides nutri-
on each side of the uterus. They secrete hormones tion for the developing infant, and promotes lac-
that regulate menstruation and secondary sexual tation (the production of milk in the breasts). It is
characteristics (see table 7-3). expelled after the birth of the child (when it is
The testes are the gonads of the male. They called afterbirth). Three hormones secreted by
are located in the scrotal sac and are suspended this gland are listed in table 7-3.
outside the body. They produce hormones that
regulate sexual characteristics of the male (see STUDENT: Go to the workbook and complete
table 7-3). the assignment sheet for 7:13, Endocrine System.
7:14 Reproductive System ♦ Identify at least three organs of the male repro-
ductive system that secrete fluids added to
Objectives semen
After completing this section, you should be able ♦ Label a diagram of the female reproductive
to: system
♦ Label a diagram of the male reproductive sys- ♦ Describe how an ovum is released from an
tem ovary
♦ Trace the pathway of sperm from where they ♦ Explain the action of the endometrium
are produced to where they are expelled from ♦ Describe at least six diseases of the reproduc-
the body tive systems
KEY TERMS
Bartholin’s glands (Bar!-tha- epididymis (eh"-pih-did!-ih- labia minora (lay!-bee"-ah
lens) muss) ma-nore!-ah)
breasts fallopian tubes (fah-low!- ovaries
Cowper’s (bulbourethral) pea"-an) penis
glands (Cow!-purrs) fertilization (fur"-til-ih-zay!- perineum (pear"-ih-knee!-
ejaculatory ducts (ee-jack!- shun) um)
you-lah-tore"-ee) labia majora (lay!-bee"-ah prostate gland
endometrium (en"-doe-me!- mah"-jore!-ah) reproductive system
tree-um) scrotum (skrow!-tum)

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DIVERSIFIED

Louise Simmers, MEd, RN

Vice President, Marketing, Career and

Delmar Cengage Learning

Cengage Learning products are represented in Canada by Nelson Education, Ltd.

For your lifelong learning solutions, visit delmar.cengage.com

Visit our corporate website at www.cengage.com

Notice to the Reader

CHAPTER 2 Health Care Systems 26

CHAPTER 3 Careers in Health Care 38

3:6 Biotechnology Research Summary 80

CHAPTER 4 Personal and Professional Qualities

CHAPTER 5 Legal and Ethical Responsibilities 103

CHAPTER 6 Medical Terminology 119

CHAPTER 7 Anatomy and Physiology 140

CHAPTER 8 Human Growth and Development 235

CHAPTER 9 Cultural Diversity 257

CHAPTER 10 Geriatric Care 275

CHAPTER 11 Nutrition and Diets 295

CHAPTER 12 Computer Technology in Health Care 314

CHAPTER 13 Promotion of Safety 333

CHAPTER 14 Infection Control 350

CHAPTER 15 Vital Signs 412

CHAPTER 16 First Aid 448

16:12 Applying Dressings and Bandages 519 Internet Searches 526

CHAPTER 17 Preparing for the World of Work 528

CHAPTER 19 Laboratory Assistant Skills 648

CHAPTER 20 Medical Assistant Skills 715

CHAPTER 21 Nurse Assistant Skills 779

CHAPTER 22 Physical Therapy Skills 930

CHAPTER 23 Business and Accounting Skills 969

Diversified Health Occupations, seventh edition, was written to pro-

OBRA Requirement—Based on Federal Law ♦ A free StudyWARE™ CD-ROM is packaged

Diversified Health WebTutor to Accompany

Electronic Classroom Manager ♦ Learning links that offer students a short

Objectives CHAPTER 16 First Aid

Review these goals before you begin reading a

key points of the chapter. Precautions

specific pieces of information. This icon key is Math Skill

presented to reinforce the meaning of the icons. Legal Responsibility

30216_16_Ch16_448-527.indd 448 1/11/08 1:21:54 PM

TODAY’S RESEARCH: TOMORROW’S HEALTH CARE

Career CAREER HIGHLIGHTS

RELATED HEALTH CAREERS

Information 13:1 INFORMATION

Sections To prevent injury to yourself and others while

30216_13_Ch13_333-349.indd 334 1/11/08 1:25:44 PM

Full-Color Photos and Illustrations

Internet INTERNET SEARCHES

Use the suggested search engines in Chapter 12:4

you find yourself unable to answer the

This seventh edition of Diversified Health Occupations is dedicated

Eleanore Cross Linda Stanhope

Carson’s Scholar Fund Omron Healthcare

Welcome to the world of health science technology educa-

Safety—Proceed with Caution Science Skill Technology

ing the structure of the human body was limited

TABLE 1-1 History of Health Care in Ancient Times

THE DARK AGES AND

TABLE 1-3 History of Health Care in the Renaissance

1350–1650 AD Rebirth of science of medicine

FIGURE 1-2 Anton van Leeuwenhoek

TABLE 1-5 History of Health Care in the 19th Century

Francis Crick and James Watson shared the Nobel