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 Contents
1 1
HOSPITAL
Departments and specialists
1
1
2 Admission 5
3 Giving directions 6
4 Medical equipment 6

2 1
MEDICAL TERMINOLOGY
Introduction to Medical terminology
9
9
2 Building words for the Medical language 9
3 How to use the Prefix, Root, Suffix List for Beginning Students 10

3 1
GASTROINTESTINAL SYSTEM
The Anatomy of GI System
14
14
2 Introduction to Digestive System Terms 15
3 Signs and Symptoms
16
4 Pathology Conditions
16
5 Laboratory Tests & Clinical Procedures
17
6 Pharmacology of Drugs acting on GI Systems
7 17
Suffix and Substances
8 Parts of the Body 18

9 Medical equipment 19

4 1
RESPIRATORY SYSTEM
The Anatomy of Respiratory System
21
21
2 Introduction to Respiratory System 22
3 Respiratory System Disorders 23
4 Respiratory System Clinical Procedures 24
5 Abbreviations Related to the Respiratory System 24
6 Respiratory System Terms 25
7 SOAP Note 25
8 Pharmacology of drugs acting on Respiratory System 26
9 Everything you need to know about COPD 26
10 Spirometry 29
11 Medical equipment 31

5 1
CARDIOVASCULAR SYSTEM
The Anatomy of Cardiovascular System
34
34
2 Introduction to Cardiovascular System 34
 3 Cardiovascular System Terms 36
4 Pathology of Cardiovascular System 36
5 Pharmacology of drugs acting on Cardiovascular System 37
6 Electrocardiogram ECG 37
7 ECG procedure for kids 38
8 Medical equipment 39

6 1
VITAL SIGNS
Introduction to vital signs
41
41

2 Disorders related to vital signs 43

3 Vital signs measurement 44

4 Medical equipment 45

7 1
BLOODSTREAM
Introduction to Blood System
48
48

2 Blood System Laboratory Tests & Clinical Procedures 49

3 Blood System Pathology 49

4 Blood System Terms 49

5 Pharmacology of drugs acting on Blood, Lymphatic and Immune System 50

6 Understanding Anemia - Symptoms 51

7 Intravenous cannulation (IV) performance 52

8 Medical equipment 53

8 1
PHARMACOLOGY
Introduction to Pharmacology
56
56

2 Pharmaceutical Formulations 57

3 Abbreviations of Drug Use 58

4 The Anatomy of a Prescription Label 58

5 Directions 59

6 Medication guides 62

9 1
URINARY SYSTEM
The Anatomy of Urinary System
64
64

2 Introduction to Urinary System 65

 3 Pathology Vocabulary 66
4 Lab Tests & Clinical Procedures 66
5 Urinary System Terms 66
6 Pharmacology of Drugs acting on Urinary System 66
7 Acute Kidney Failure 67
8 What is Urinary Catheterization 70
9 Medical equipment 71

10 1
REPRODUCTIVE SYSTEM
Parts of Female Reproductive System
74
74

2 Introduction to Female Reproductive System 74

3 Female Reproductive System Pathology 76

4 Clinical Tests & Procedures 77

5 Female Reproductive System Terms 77

6 An overview of the pelvic examination 78

7 How is it done? 79

8 Medical equipment 80
1 Departments and specialists
Hospital
1
Accident and emergency (A&E) Pathology department

This department (sometimes called Casualty) Pathologist

is where you're likely to be taken if you've
called an ambulance in an emergency. This
department operates 24 hours a day, every
day and is staffed and equipped to deal with
all emergencies.
A branch of medical science that involves the
study and diagnosis of diseases through the
examination of surgically removed organs,
tissues (biopsy samples), bodily fluids, and in
some cases the whole body (autopsy).

Biochemistry department
Outpatient department

In this department, people come to the

hospital for a consult and not admission. The Clinical Biochemistry commonly performs
patients seek medical advice from specific dozens of different tests on serum or plasma.
department depending on their problems. These tests, mostly automated, includes
Doctors provide a prescription of medication quantitative testing for a wide array of
for them to take for a certain period of time. substances, such as lipids, blood sugar,
enzymes, and hormones.
Diagnostic imaging department
Pharmacy department

The study and application of

imaging technology like x - ray
and radiation to diagnose and
treat diseases.
Microbiology department
Pharmacist
This department is responsible for drugs in a
hospital, including purchasing, supplies and
distribution.

Gastroenterology deparment
Microbiologist

Gastroenterologist/ GI doctor
The microbiology department looks at all
aspects of microbiology, such as bacterial
This department investigates and treats
and viral infections.
digestive and upper and lower gastrointestinal
Endoscopy department
diseases.
Cardiology department
Endoscopist

Cardiologist
Medical procedures are performed with
endoscopes, using camera and light to This department provides medical care to
visualize structures within the body, such as patients with their heart or circulation
the digestive tract and genitourinary system. problems.

1
1
Hematology department Gynaecology demarment

Hematologist Gynaecologist

Hematology services work closely with the

Gynaecology department investigates and treats
hospital laboratory. These doctors treat blood
diseases and malignancies linked to the blood, problems of the female urinary tract and
with both new referrals and emergency reproductive organs, such as endometritis,
admissions being seen. infertility and incontinence.

Nephrology deparment Obstertrics department

Nephrologist / Kidney specialist

Obstetrician
This department monitors and assesses
patients with kidney (renal) problems. The area of medicine that deals with pregnancy
Nephrologists (kidney specialists) will liaise and the birth of babies.
with the transplant team in cases of kidney
transplants. Martenity/ neonatal/ pediatrics department
Urology department

Urologist Pediatrician

The urology department is run by consultant

urology surgeons and investigates areas linked
to kidney and bladder conditions.
Pulmonary department
This ward provides antenatal care, delivery of
babies and care during childbirth, and postnatal
support.
Neurology department

Pulmonologist
Neurologist

This department monitors and assesses

This unit deals with disorders of the nervous
patients with various lung problems and
system, including the brain and spinal cord. It's
conditions.
run by doctors who specialize in this area and
Otolaryngology department
their staffs.

Dermatology department

Dermatologist
Otolaryngologist/ ENT doctor

Doctors in this ward treat the diseases and This department treats diseases and
conditions of the ear, nose and throat. conditions of the skin.

2
 1
Dentistry department Oncology department

Dentist /Orthodontist Oncologist

This department provides radiotherapy and a

full range of chemotherapy treatments for
This department treats diseases and conditions
cancerous tumors and blood disorders.
of people’s teeth.
Rheumatology department Radiotherapy department

Rheumatologist Radiotherapist

Rheumatologist care for and treat patients for This department provides radiotherapy (X-ray)
musculoskeletal disorders such as: bones, joints, treatment for conditions such as malignant
ligaments, tendons, muscles and nerves. tumors and cancer.

Geriatrics department Nutrition and dietetics department

Geriatrician

Dietician and Nutritionist

The elderly services department looks after a
Nutritions and dietichians provide specialists’
wide range of problems associated with the
advice on diet for hospital wards and
elderly.
Psychiatry department outpatient clinics, forming part of a
multidisciplinary team.

Traditional medicine department

Psychiatrist

Traditional medicine doctor

This department deals with patients with

Doctors in this department use traditional
mental illness and disorders.
ingredients, herbal medicine, non-drug therapies
Ophthamology department for treatment.

Physiotherapy department
Ophthamologist

Physiotherapist
This department provides a range of eyes
services for adults and children including: laser Physiotherapists work through physical
treatments, optometry, orthoptics, ophthalmic therapies such as exercise, massage, and
imaging, etc. manipulation of bones, joints and muscle tissues.

3
1
General surgery Intensive care unit (ICU)

Critical care unit (CCU)

Surgeon Intensive treament unit (ITU)

This department provides intensive treatment

The general surgery ward covers a wide range of
medicine and caters to patients with severe and
types of surgeries and procedures on patients.
life-threatening illnesses and injuries.
Anesthetics department Admission

Anesthesiologist/ anesthetist
At the admitting department, the patient will be
required to provide personal information and
Doctors in this department give anesthetic for
sign consent forms before being taken to the
operations and procedures. Anesthetic is a drug
hospital unit or ward. If the individual is critically
or agent that produces a complete partial loss of
ill, then, this information is usually obtained from
feeling.
a family member.
Medical record department
Infection control department

Includes a variety of types of “notes” entered

This department is primarily responsible for
over time by health care professionals, recording
conducting surveillance of hospital-acquired
observations and administration of drugs and
infections, investigating and controlling
therapies, orders for the administration of drugs
outbreaks or infection cluster among patients
and therapies, test results, x-ray, reports, etc.
and health care personnel.

General service Finance department

Includes services such as porting, catering,

housekeeping, security, health & safety, switch,
laundry, food services and the management of
facilities such as parking, baby tagging, access
control, etc.
Social work department
This department performs all works related to
budget and ideal use of the items of such
budget. Also, it prepares payroll and monthly
wages, and concludes contacts of operation and
maintenance and purchases. In addition, it makes
available all amounts of money require for
procurement of all material and equipment.

This department helps patients and their families

deal with psychosocial issues and stresses Purchasing & supplies department
related to coping with illness, addresses the
challenges families face, increases accessibility to
health care and other human services, and Purchasing & supplies department is
serves as a bridge between the hospital setting responsible for the procurement function of the
and a patient’s family life, home and community. hospital.

4

2 Admission Hi! Uhm…
Receptionist: Hello, thank you for registering
with us. I just need to ask you a few questions
to complete your patient registration form. Can
I just ask what your title is?
Patient: Yes, my title is Miss.
Receptionist: Thank you, and what is your
surname?
Patient: Do you mean my family name?
Receptionist: Yes, that’s right, your family
name.
Patient: It’s Al Thani.
Receptionist: Can you spell that for me, please?
Patient: Yes, my surname is Al Thani, that’s A-L
and then T-H-A-N-I.
Receptionist: And your first name?
Patient: Laila.
Receptionist: That’s great, thank you Laila. Can I
ask if you are single, married, separated,
widowed or divorced?
Patient: I’m single.
Receptionist: And what’s your date of birth,
please?
Patient: September 29th, 2002.
Receptionist: September 29th, 2002, OK. And
your house number?
Patient: It’s number 24.
Receptionist: Okay, number 24 and what’s the
street, please?
Patient: It’s Morden Street in Manchester.
Receptionist: Great, so it’s in the city of
Manchester?
Patient: Yes, that’s correct.
Receptionist: And do you have any children
Laila?
Patient: No, no children.
Receptionist: Right, and can you tell me your
phone number, please?
Patient: Yes, it’s 0-7-9-7-2-9-0-8-2-0-7.
Receptionist: Let me just repeat that. So that’s
0-7-9-7-2-9-0-8-2-0-7 is that correct?
5
1
Hello! Thank you for
registering with us.
Patient: Yes, that’s correct.
Receptionist: Good, and who is your next of kin?
Patient: Hmm I don’t understand. What do you
mean by next of kin?
Receptionist: Um, who is the person we can
contact in case of an emergency?
Patient: Oh yes, my mother Fatima Al Thani.
Receptionist: That’s great thanks. We’re nearly
finished now, but I just need to ask for your
mother’s contact number, please.
Patient: Yes, it’s the same as my number, that’s 0-
7-9-7-2-9-0-8-2-0-7.
Receptionist: Okay, and now I just have a few
questions about your medical history. Have you
had any immunizations?
Patient: No, none.
Receptionist: And any health-screening tests?
Patient: No, I don’t think so …. Mm no I haven’t
had any health-screening tests.
Receptionist: Okay, good and are you allergic to
any medicines?
Patient: Yes, Aspirin.
Receptionist: Did you say Aspirin?
Patient: Yes, that’s right, I’m allergic to Aspirin.
Receptionist: Right, and can you tell me about any
operations that you have had?
Patient: Oh no, I haven’t had any operations.
Receptionist: That’s good, no operations then.
And are you taking any medications?
Patient: None.
Receptionist: Okay, and how would you describe
your general health? Is it excellent, good, fair or
poor?
Patient: Oh, I think it’s excellent, I have excellent
health.
Receptionist: That’s very good to hear and now
the last question. Why do you want to see the
nurse today?
Patient: Well, I keep getting headaches.
1
3 Giving directions

Radiology
department HALL

Orthopaedics
department Vending
machine

RECEPTION

Receptionist: Good morning. How can I help?

Visitor: I’m looking for the radiology department.
Receptionist: Ah, see the corridor on the left?
Visitor: Yes, behind the vending machine?
Receptionist: Okay, go down the corridor to the end and turn right into a hall. Cross the hall. On the
opposite side is a door. Go through the door and you will find the radiology department. It’s on the right of
the orthopaedics department.

4 Medical Equipment

(1) (2) (3)

(4) (5) (6)

6
 1

(7) (8) (9)

(10) (11) (12)

(1) Hospital bed: a bed specially designed for hospitalized patients or others in need of some form of
health care.

(2) Examining table: a table on which the patient lies during a medical examination.

(3) Gloves: a covering for the hand and wrist, with separate parts for the thumb and each finger.

(4) Medicine trolley: a wheeled container carrying medicine and equipment for use in emergency
resuscitations.

(5) Medicine cabinet: a cabinet used for storing medicines in medical department.

(6) Call bell: a bell speaks for patients who can't talk. It connects the immobile or disabled patient to the
nursing station.

(7) Pillow: a cloth bag filled with soft artificial fibers that supports a patient’s head while resting or
sleeping.

(8) Patient chart: a complete record of a patient's key clinical data and medical history.

(9) Sharps bin: a hard plastic container that is used to safely dispose of biomedical waste.

(10) Drip stand: a device for administering a fluid drop-by-drop into a vein via an intravenous (IV) route.

(11) Patient pyjamas: soft, loose clothing for patients worn in bed.

(12) Gown: a long loose piece of clothing worn in a hospital by someone doing or having an operation.

7
1
GLOSSARY

8
 1
Medical Terminology

Introduction to Medical terminology

2
Medicine has a very distinct and highly specialized language. It is necessary for anyone wishing to pursue
a successful career in the medical field to acquire comprehension in this system of communication,
including Allied Healthcare professionals.

Medical vocabulary will be taught with specific emphasis on root or stem words, prefixes, suffixes, and
abbreviations. Medical terminology is the study of rules of medical word building. Students receive a
thorough grounding in basic medical terminology through a study root words, prefixes, and suffixes.

The study will emphasize the use of medical terms as well as spelling and proper pronunciation. Terms
associated with anatomy, physiology, pathology, and diagnostic tests of different systems are discussed
but no previous knowledge of these topics is necessary.

There are three things to keep in mind as you study medical terminology.

First is to analyze words by dividing them into component parts.

By learning the tools of word analysis, you will have an easier time understanding complex terminology.
Do not simply memorize the terms. Instead think about dividing the terms into their component parts.

Second, relate the medical terms to the structure and function of the human body.
Medical terms explained in the right context will be easier to remember. No previous knowledge of
biology, anatomy, or physiology is needed for the study of medical terminology.

Third, be aware of spelling and pronunciation problems.

Some medical terms are pronounced alike but they are spelled differently. Even when the terms are
spelled correctly they could be pronounced incorrectly leading to misunderstanding.

2 Building words for the Medical language

When learning the language of medicine, the first thing to do is to understand how to divide words into
their component parts. Let’s look at an example: Hematology

– Hema (blood): root o: Combining vowel -logy (process of study): suffix

The root is the foundation of the word. All medical terms have one or more roots.

The suffix is the word ending. All medical terms have a suffix.

The combining vowel, usually an “o” links the root to the suffix or to another root. The combining
vowel has not meaning of its own. It just joins one work part to another.

It is useful to read the meaning of the medical term starting from the suffix and then going back to the
beginning of the term. Here are three general rules to remember:

READ the meaning of the word from the suffix back to the beginning of the term and across.

DROP the combining vowel before a suffix beginning with a vowel: gastritis, not gastroitis.

KEEP the combining vowel between the two roots: gastroenterology, not gastrenterology.

9
2
There are two additional parts commonly found in medical terms: the combining form and the prefix.

The combining form is simply the root plus the combining vowel.

The prefix is a small part attached at the beginning of the term. Not all medical terms have a prefix. The
prefix can have important influence on meaning.

Summarized in The Language of Medicine by Davi-Ellen Chabner are the 5 basic elements from which
medical terms are built:

1. Root: foundation of the term (all medical terms have one or more root elements).

2. Suffix: word ending (all medical terms have a suffix element).

3. Prefix: word beginning (not all terms have a prefix).

4. Combining Vowel: vowel (usually o) that links the root to the suffix or the root to another root.

5. Combining Form: combination of the root and the combining vowel.

3 How to use the Prefix, Root, Suffix List for Beginning Students

Here are the steps to decode a complex scientific medical term:

1. First identify a term and separate it into 2 or 3 segments or syllables.

2. Check the left column in the PRS List. All of the word segments in the left column are a portion or
segment of a longer medical term.
3. Find the segment you are interested in, look at the second column. You will find a brief meaning for
that segment. Each meaning can be preceded by the phrase “pertaining to”.
4. Check the third column where you will find an example of a word using the segment of interest.
Sometimes the example will puzzle you. Repeat the steps above to clarify.

Prefix, Root, Suffix (PRS) List for Beginning Health Care Students
Segment Meaning Example Segment Meaning Example
A B
a-- absence of atypical, apnea twice or
ab-- away from Abduct bi-- double bilateral
acous-- hearing Acoustic blepharo eye lid blepharospasm
ad-- toward Adduct brachi-- arm brachial plexus
adeno-- gland adenocarcinoma brady-- slow Bradycardia
adip-- fat adipose tissue C
-algia pain -- carcin-- cancer carcinogenic
an-- without Anuria cardio-- Heart cardiomegaly
ana-- up, apart -- cata-- down --
--cele pouching cystocele
angio-- vessel angiogram
--centesis puncture amniocentesis
ante-- before antepartum
cephal-- head hydrocephalic
anti-- against antibiotic
cerebro-- brain cerebral cortex
--ase enzyme Lipase cholecysto
arthro/i-- joint arthritis -- gall bladder cholecystectomy
--asthenia weakness myasthenia chondro cartilage costochondral joint
auri-- ear auricular --cidal kill bactericidal
auto-- self, own -- coagula curdle, clot coagulate

10
 2
Segment Meaning Example Segment Meaning Example
--cocci plural bacteria -- hepato-- Liver hepatomegaly
berry-shaped
--coccus -- homeo-- constant homeostasis
bacterium
contra-- opposite contralateral hydro/a-- water hydrocephalus
cryo-- cold cryosurgery high,
hyper-- hypertension
cutane-- skin subcutaneous excessive
cysto-- bladder cystotomy hypno-- sleep hypnotic medication
-cyte cell -- hypo-- low hypothyroidism
cyto-- cell Cytology
hyster-- uterus hysterectomy
D
de-- away from dehydration I
dermat-- skin dermatological --ia condition anemia
dextro-- right dextrocardia --iac pertaining to cardiac
Through, pathological
dia-- -- --iasis cholelithiasis
complete state
don/ent teeth Dental iatrogenic fluid
iatro-- physician
dorsi-- the back Dorsal overload
--dynia pain pleurodynia not, into,
in-- --
dys-- difficulty dyspnea within
E infra-- below infraclavicular nodes
ec-- out, away ectopic pregnancy inter-- between intercostal space
--ectomy removal appendectomy
intra-- within intracranial pressure
edema swelling lymphedema
ipsi-- the same ipsilateral
--emesis vomiting hematemesis
strabismus,
blood --ismus spasm
--emia anemia vaginisimus
condition
iso-- equal isotonic solution
encephalo-- brain encephalitis
--itis inflammation arthritis
endo-- inside endoscopy
J
entero intestine gastroenterologist
epi-- on, outside of epidural juxto-- next to juxtaposition
erythro red erythrocyte K
--esthes sensation anesthesia kypho-- humped kyphotic spine
eu-- good, normal -- L
ex-- out, outside --
labia/o lip nasolabial fold
G
lacrim Tear lacrimal gland
gastri/o-- stomach gastric
condition of lacta/o-- Milk lactation
--genesis producing, -- laparo abdomen laparoscopy
forming leuko white leukocyte
--genic producing cardiogenic shock lingua tongue sublingual gland
genito-- reproduction genital lip-- fat lipoma
geri/o-- old age geriatric
gingival --listhesis dislocation spondylolisthesis
gingiva gum lith/o stone cholelithiasis
hyperplasia
glossopharyngeal --logy study of --
glossal tongue
nerve --lysis dissolve bacteriolytic
gyne-- woman gynecology
M
--globin protein hemoglobin
mal-- bad malodorous
--globulin protein thyroglobulin
-- written, --malacia softening osteomalacia
electrocardiogram --megaly enlargement cardiomegaly
gram/graph drawn
H melan/o-- black melanous stool
process of beyond,
--graphy
recording meta-- change --
hemato-- blood hematocrit --meter to measure thermometer
hemi-- Half Hemiplegia micro-- small --
hemo-- blood hemoglobin mort-- dead postmortem

11
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Segment Meaning Example Segment Meaning Example
my/o-- muscle myositis out
--rrhoea flowing diarrheal stool
myc/o-- fungus mycotic toenails
re-- back, again --
myel/o-- spinal cord myelogram behind,
myel/o bone marrow myelogenous retro-- --
backward
N S
narco-- sleep narcotic sanguine blood serosanguinous
neo-- new neoplasm sarco-- muscle sarcoma
nephro-- kidney nephritis schizophrenic
O schiz-- split
delusion
--odyn painful pleurodynia atherosclerotic
onc/o-- tumor oncology scler/o hard
vessels
--opsy to view -- arthroscopic knee
optic eye, vision optic nerve scope view
surgery
straight, sero clear fluid Immune serum
ortho-- orthodontist
upright semi-- half semiconscious state
--osis disease psychosis
ossi-- bone ossification somat/o-- body somatic complaint
---ostomy opening colostomy spondylo-- spine spondylodiscitis
oto-- ear otoscope peristalsis of the
--stalsis contraction
oxi-- oxygen oxidation intestine
P --stasis/ic Stop hemostatic agent
pan-- all -- --staxis dripping epistaxis
--paresis Weakness hemiparesis stoma-- mouth stomatitis
--pathy Disease neuropathy --ostomy opening colostomy
--pectoris Chest pectoral muscles sub-- beneath subcutaneous
ped, pes Foot dorsalis pedis super/ra-- above supra ventricular
--penia deficiency ostopenia T
--pepsia stomach dyspepsia tachy-- rapid tachycardia
percutaneous --tension pressure hypertension
per-- through
insertion tetan-- Rigid tetanus
peri-- around periorbital fracture therm-- heat thermometer
--phagia swallowing dysphagia -therapy treatment --
--phasia speech aphasia thorax-- upper chest thoracotomy
--phlebo blood, vein phlebotomy
--phobia fear of claustrophobia thrombo-- blood clot deep vein thrombosis
photo-- light photophobia incision,
--plasia growth hyperplasia --tomy --
cutting into
--plasty repair rhinoplasty trans-- across transfusion
--plegia paralysis quadriplegic --tripsy crushing lithotripsy
pleura/o the ribs pleural cavity --trophy development hypertrophy
--pnea breathing dyspnea
tympan/o-- eardrum tympanic membrane
pneumo-- lung pneumothorax
poly-- many, much -- U
post-- after postmortem uni-- one unilateral
before, in uri/o-- urine urinalysis
pre-- V
front of
presby-- old age presbyopia vaso-- vessel vasoconstriction
before, ven-- vein peripheral venous
pro-- catheter
forward
procto-- rectum proctology
psyc-- Mind psychotropic drug ventro-- belly, front ventral hernia
dropping, vesico-- bladder vesico-vaginal fissure
--ptosis falling, -- internal
viscera-- visceral cavity
prolapse organs
pyo-- Puss pyogenic bacteria X
pyro-- Fever antipyretic drug xero-- dry xerostomia
R Z
--zyme fermentation enzyme
--rrhaphy suturing herniorrhaphy

12
 2
GLOSSARY

13
3
1
Gastrointestinal system
The Anatomy of GI System
• Oral cavity: where gastrointestinal tract
begins.
• Tongue: extends across the floor of the oral
cavity and muscles attach it to the lower
jawbone.
• Pharynx: throat, the common passageway
for food from the mouth and for air from
the nose.
• Salivary Glands: parotid, sublingual, and
submandibular glands.
• Esophagus: tube connecting the throat to
stomach.
• Liver: large organ located in the right upper
quadrant of the abdoment, secretes bile,
store sugar, iron, and vitamins.
• Stomach: muscular organ that receive food
from the esophagus.
14
• Gallbladder: small sac under the liver, stores
biles.
• Pancreas: organ behind the stomach,
produces insulin and enzymes.
• Large intestine (Colon): extends from the
end of the ileum to the anus.
• Small intestine: extends for 20 feet from the
pyloric sphincter to the first part of the
large intestine.
• Appendix: blind pouch hanging from the
cecum in the right lower quadrant.
• Rectum: last section of the large intestine,
connecting the end of the colon and the
anus.
• Anus: terminal end or opening of the
digestive tract to the outside of the body.
 3
2 Introduction to Digestive System Terms
The digestive or gastrointestinal tract begins with the mouth and ends at the anus.
There are four functions of the digestive systems:
• Ingestion
• Digestion
• Absorption
• Elimination.
The gastrointestinal tract starts with the oral cavity.
Next is the pharynx or throat which is a muscular tube that serves as a passageway food to the
esophagus.
The esophagus is a 9 to 10 inch muscular tube that extends from the pharynx to the stomach. The
stomach prepares food for the small intestine.
The small intestine or small bowel extends 20 feet from the pyloric sphincter to the large intestine. Next
is the large intestine which extends from the end of the small intestine to the anus.
Other important organs of the digestive system are the liver, gallbladder, and pancreas.

3 Signs and Symptoms

Constipation Diarrhea
Anorexia Nausea

(Lack of appetite) (Unpleasant sensation in the (Difficulty in passing stools) (Frequent passage of loose
stomach with a tendency vomit) watery stools)

Dysphagia Flatus hematochezia Melena

(Passage of fresh, bright red (Black, tarry stools; feces

blood from the rectum) containing digested blood)
(Difficulty in swallowing) (Gas expelled through the anus)

Jaundice Ascites
Steatorrhea

(Yellow-orange coloration of the skin and whites of the (Abnormal accumulation of (Fat in feces)
eyes caused by high levels of bilirubin in the blood) fluid in the abdomen)

15
3
4 Pathology Conditions

Condition Description
Dental caries tooth decay
Periodontal disease inflammation and degeneration of gums, teeth, and surrounding bone

Esophageal cancer malignant tumor of esophagus

Esophageal varices swollen, varicose veins at the lower end of the esophagus
Gastric cancer malignant tumor of the stomach

Gastroesophageal reflux
solids and fluids return to the mouth from the stomach
disease (GERD)

Hernia protrusion of an organ or part through the tissues and muscles nomally containg it
Colonic polyps polyps protrude from the mucous membrane of the colon
Colorectal cancer adenocarcinoma of the colon or rectum, or both
Crohn’s Disease chronic inflammation of the intestinal tract
Hemorrhoids swollen, twisted, varicose veins in the rectal region

Inflamatory bowel disease

Inflamation of the colon and small intestine
(IBD)

Intussusception telescoping of the intestines

Inrritable bowel Syndrome

group onf GI symptoms but without defined abnormalities in the intestines
(IBS)

Ulcerative colitis chronic inflamation of the colon with presence of ulcers

Cholelithiasis gallstones in the gallbladder
Cirrhosis chronic degenerative disease of the liver

Hepatocellular Carcinoma
liver cancer
(HCC)

Pancreatic cancer maglinant tumor of pancreas

Pancreatitis inflamation of the pancreas
Viral hepatitis inflamation of the liver caused by a virus

5 Laboratory Tests & Clinical Procedures

Term
stool guaiac test or Hemoccult test
cholangiography
computed tomography (CT)
abdominal ultrasonography
endoscopic ultrasonography
magnetic resonance imaging (MRI)
Definition
test to detect occult blood feces
x-ray examination of the biliary system performed after injection of
contrast into the bile ducts
a series of x-ray images are taken in multiple views
sound waves beamed into the abdomen produce an image of abdominal
viscera
use of an endoscope combined with ultrasound toexamine the organs of
the gastrointestinal tract
magnetic waves produce images of organs andtissues in all three planes
of the body

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Term Definition

gastrointestinal endoscopy visual examination of the gastrointestinal tract using an endoscope

visual examination of the abdomen with a laparoscope inserted through small
laparoscopy
incisions in the abdomen

6 Pharmacology of Drugs acting on GI Systems

Various pharmaceutical agents are available to counteract abnormal conditions that occur in the GI tract.
Antacids counteract or decrease excessive stomach acid, the cause of heartburn, gastric discomfort, and
gastric reflux. Antidiarrheals and antiemetics help preserve water and electrolytes, which are essential
for body hydration and homeostasis. Medications that increase or decrease peristalsis help regulate the
speed at which food passes through the GI tract. These drugs include agents that relieve “cramping”
(antispasmodics) and those that help in the movement of material through a sluggish bowel (laxatives).

Drugs Used to Treat GI Disorders

This table lists common drug classifications used to treat digestive disorders, their therapeutic actions,
and selected generic and trade names.

Classification Effects

to treat the symptoms of too much stomach acid such as stomach upset,
antacids
heartburn, and acid indigestion.

antidiarrheals to treat sudden diarrhea (including traverler’s diarrhea).

antiemetics to against vomiting and nausea.

antispasmodics to help to reduce the symptoms of stomach and intestinal cramping.

to help relieve and prevent occasional heartburn by lowering the amount of

histamine-2 (H2) blockers
acid your stomach makes

laxatives to stimulate or facilitate bowel movements.

to reduce the production of acid by blocking the enzyme in the wall of stomach
proton pump inhibitors
that procedures acid.

7 Suffix and Substances

Suffix Suffix
Combining Form Meaning Combining Form Meaning
-ase ezyme -plasty Surgical repair
-chezia Defecation, elimination of -ptysis spitting
waste
-rrhage/ rrhagia Bursting forth
-iasis Abnormal condition
-rrhaphy suture
-prandial meal
-rrhea Flow, discharge
-ectasis dilation
-spasm Involutary contraction of
-ectasia widening muscle
-emesis vomiting -stasis Stoping, controlling
-pepsia digestion -stenosis Narrowing, tightening
-phagia Eating, swallowing -tresia opening

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Suffix Suffix
Combining Form Meaning Combining Form Meaning
-ase ezyme -plasty Surgical repair
-chezia Defecation, elimination of -ptysis spitting
waste
-rrhage/ rrhagia Bursting forth
-iasis Abnormal condition
-rrhaphy suture
-prandial meal
-rrhea Flow, discharge
-ectasis dilation
-spasm Involutary contraction of
-ectasia widening muscle
-emesis vomiting -stasis Stoping, controlling
-pepsia digestion -stenosis Narrowing, tightening
-phagia Eating, swallowing -tresia opening

8 Parts of the Body

Combining Form Meaning Combining Form Meaning

An/o anus ile/o ileum
Append/o appendix Jejun/o jejunum
Appendic/o appendix Labi/o lip
Bucc/o cheek Lapar/o abdomen
Cec/o cecum Lingu/o tongue
Celi/o Belly, abdomen Mandibul/o Lower jaw, mandible
Cheil/o lip Odont/o tooth
Cholecyst/o gallbladder
Or/o mouth
Choledoch/o Common bile duct
Palat/o palate
Col/o colon
Pancreat/o pancreas
Dent/i teeth
Peritone/o peritoneum
Duoden/o duodenum
Pharyng/o throat
Enter/o Intestines/ usually small
intestine Proct/o Anus and rectum

Esophag/o esophagus Pylor/o Pyloric sphincter

Fachi/o face Rect/o rectum

Gastr/o stomach Dialaden/o Salivary gland

Gingiv/o gums Digmoid/o Sigmoid color

Gloss/o tongue Stomat/o mouth

Hepat/o liver Uvul/o uvula

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9 Medical equipment

(1) (2) (3)

(4) (5) (6)

(7) (8) (9)

(1) Bedpan: a receptacle used by a bedridden patient as a toilet.

(2) Adult diaper: a disposable garment worn instead of underwear to help alleviate leaks from urinary or
fecal incontinence.

(3) Stool container: a hollow object, such as a box or a bottle, that is used for holding stool samples.

(4) Endoscope: an instrument which can be introduced into the body to give a view of its internal parts.

(5) Mask: a covering for all or part of the face.

(6) Soap: a substance used with water for washing and cleaning.

(7) Hand rub: A rapidly drying solution that contains ethanol or propanol and is applied to the hands after
contact with patients.

(8) Paper towel: a piece of absorbent paper used for wiping up liquids or drying things.

(9) Gargle: A liquid preparation of H2O or other substance used as an intraoral wash, which is not
intended to be ingested.

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GLOSSARY

20
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Respiratory System

The Anatomy of Respiratory System

4
Trachea

Pulmonary artery

Pulmonary vein
Hyoid bone

Primary bronchi
Alveolar
Secondary bronchi

Tertiary bronchi
Bronchioles

Alveoli

Cardiac notch

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2 Introduction to Respiratory System

To understand the process of breathing.

In humans, the main organs responsible for respiration are present in the thoracic cavity. In the thorax
region, the ribcage and a dome-shaped fibrous tissue, known as the diaphragm, are observed. Present
within the ribcage are the pleural membranes which includes the lungs.

The right lung is divided into 3 lobes: the right superior, right middle and the right inferior lobe. The left
lung is smaller and has only two lobes: the left superior and the left inferior lobe. Both the lungs are
associated externally with small tubular bronchi which unite and extend into the trachea. The trachea has
incomplete C shaped rings of cartilage which prevent the tracheal wall from collapsing. The trachea leads
into the pharynx which is connected to the nostrils.

As we breathe in air, the oxygen molecules enter the nostrils and travel downwards through the pharynx
and trachea to finally reach the bronchi. From each bronchus oxygen travels into the lungs. Within the
lungs, the bronchus divides repeatedly to form bronchiole. Oxygen travels through these bronchioles and
reaches the alveoli. Each of which is surrounded by a network of capillaries. A section of one alveolus
shows the presence of numerous alveolar chambers with pores.

Blood containing RBCs is seen flowing through the capillaries. The oxygen molecules from the alveolus
diffuse into the capillary and then get absorbed by the bluish purple RBC's. This causes oxygenation of
the RBC's, and a transition in their color from bluish purple to red is observed. The blood moving into the
alveolus contains RBCs in carbon dioxide molecules. These molecules are released into the alveolus. The
carbon dioxide collects in the alveolar chamber and then from the alveolus. It travels through the
bronchioles into the bronchus which finally reaches the trachea and is breathed out through the nostrils.

So the process of breathing in, air rich in oxygen, is called inhalation. After the contraction of the muscular
diaphragm, the lungs expand and the air rushes in resulting in the inflation of the alveoli. During
exhalation, the diaphragm moves up and the lungs contract, thus the alveoli deflate causing the air to be
forced out. This exhaled air is rich in carbon dioxide. This process of inhalation and exhalation is known as
respiration which is approximately 20 times per minute.

Summary: In the thorax region, the ribcage in the diaphragm are observed, which play a vital role in
respiration. Present within the ribcage are the pleural membranes which enclose the lungs. The right lung
consists of three lobes. While the left lung has only two lobes. Both the lungs are associated externally
with bronchi which unite and extend into the trachea. As we breathe the oxygen molecules enter the
nostrils and travel downwards through the pharynx and trachea to finally reach the bronchi. From each
bronchus oxygen travels into the lungs. Within the lungs, the bronchus divides repeatedly to form
bronchioles. Oxygen travels through these bronchioles and reaches the alveoli. Each of which is
surrounded by a network of capillaries. As blood flows through the capillaries, the oxygen molecules from
the alveolus diffuse into the capillary. This causes oxygenation of the RBC's. The carbon dioxide molecules
are released into the alveolus. They are collected in the alveolar chamber and then from the alveolus. It
travels through the bronchioles into the bronchus which finally reaches the trachea and is breathed out
through the nostrils.

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3 Respiratory System Disorders

Respiratory System Disorders

Term Definition

acute viral infection of infants and children with obstruction of the larynx,
croup
accompanied by barking cough and stridor

acute infection of the throat and upper respiratory tract caused by the diphtheria
diphtheria
bacterium

epistaxis nosebleed

whooping cough; highly contagious bacterial infection of the pharynx, larynx, and
pertussis
trachea caused by Bordetella pertussis

chronic bronchial inflammatory disorder with airway obstruction due to bronchial

asthma
edema and constriction and increased mucus production

inherited disorder of exocrine glands resulting in thick mucus secretions in the

cystic fibrosis (CF)
respiratory tract that do not drain normally

emphysema hyperinflation of air sacs with destruction of alveolar walls

acute inflammation and infection of alveoli, which fill with pus or products of the
pneumonia
inflammatory reaction

pulmonary edema fluid in air sacs and bronchioles

Pulmonary embolism
clot or other material lodges in vessels of the lungs
(PE)

mesothelioma rare malignant tumor arising in the pleura

pleural effusion abnormal accumulation of fluid in the pleural space

pneumothorax collection of air in the pleural space

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4 Respiratory System Clinical Procedures

Respiratory System Clinical Procedures

Term Definition

chest x-ray (CXR) radiographic image of the thoracic cavity

computed tomography (CT) scan computer-generated series of x-ray images show thoracic structures in

of the chest cross section and other planes

magnetic resonance imaging magnetic waves create detailed images of the chest in frontal, lateral,

(MRI) of the chest cross-sectional, and other planes

detection device records radioactivity in the lung after intravenous

ventilation-perfusion (V/Q) scan injection of a radioisotope and inhalation of a small amount of radioactive

gas (xenon)
bronchoscopy fiberoptic endoscope examination of the bronchial tubes
placement of a tube through the mouth into the pharynx, larynx, and
endotracheal intubation
trachea to establish an airway
tests that measure the ventilation mechanics of the lungs; airway

pulmonary function tests (PFTs) function, lung volume, and the capacity of the lungs to exchange oxygen

and carbon dioxide efficiently

thoracentesis surgical puncture to remove fluid from the pleural space

tracheostomy surgical creation of an opening into the trachea through the neck

5 Abbreviation Related to the Respiratory System

Abbreviation Meaning

ARDS Acute respiratory distress syndrome

Br Chronic bronchitis

CSB Cheyne-Stoke breathing

COPD Chronic obstructive pulmonary distress

CF Cystic fibrosis

ETT Endotracheal intubation

FESS Functional endoscopic sinus surgery

HBOT Hyperbaric oxygen therapy

PFT Pulmonary function tests

RF Respiratory failure

SIDS Sudden infant death syndrome

TB Tuberculosis

URI Upper respiratory infection

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6 Respiratory System Terms 7 SOAP Note

Combining form Meaning SOAP Note: RESPIRATORY EVALUATION

adenoid/o adenoids
Emergency Department Record
alveol/o aveolus, air sac
Date: February 1, 20xx
bronch/o; bronchi/i bronchial tube, bronchus
Time Registered: 1345 hours
bronchiol/o bronchiole, small bronchus
Patient: Flowers, Richard
capn/o carbon dioxide
Physician: Samara Batichara,MD
coni/o dust
Chief Complaint: SOB
cyan/o blue
Medications: Vytorin 10/20 mg daily; Toprol-XL
epiglott/o epiglottis 50 mg daily; Azmacort 2 puffs three times a
day; Proventil 2 puffs every 6 hours.
laryng/o larynx, voice box
S: This 49-year-old man with Hx of COPD is
lob/o lobe of the lung
admitted because of exacerbation of SOB over
mediastin/o mediastium the past few days. Patient was a heavy smoker
and states that he quit smoking for a short time
nas/o nose
but now smokes 3–4 cigarettes a day. He has a
orth/o straight, upright Hx of difficult breathing, hypertension, COPD,
and peripheral vascular disease. The patient
ox/o oxygen
underwent triple bypass surgery in 19xx.
pector/o chest
O: T: 98.9 F. BP: 180/90. Pulse: 80 and regular.
pharyng/o pharynx, throat R: 20 and shallow. PE indicates scattered
bilateral wheezes and rhonchi heard anteriorly
phon/o voice
and posteriorly. Compared with a portable
phren/o diaphragm chest film taken 22 months earlier, the current
study most likely indicates interstitial vascular
pleur/o pleura
congestion. Some superimposed inflammatory
pneum/o; air, lung change cannot be excluded. There may also be
pneumon/o
some pleural reactive change.
rhin/o nose A: 1. Acute exacerbation of chronic obstructive
sinus/o sinus, cavity pulmonary disease.

spir/o breathing 2. Heart failure.

tel/o complete 3. Hypertension.

thorac/o chest 4. Peripheral vascular disease.

tonsill/o tonsils P: Admit to hospital.

trache/o trachea, windpipe Samara Batichara, MD

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8 Pharmacology of drugs acting on Respiratory System

Pharmacology

Several classes of drugs are prescribed to treat pulmonary disorders. These include antibiotics, which are
used to treat respiratory infections, and bronchodilators, which are especially effective in treating COPD
and exercise-induced asthma. Steroidal and nonsteroidal anti-inflammatory drugs are important in the
control and management of many pulmonary disorders.

Drugs Used to Treat Respiratory Disorders

Classification Effects
to destroy or slow down the growth of bacteria by disrupting their membranes or one or
antibiotics more of the metabolic processes.

to help trat symptoms such as: congestion, runny nose, sneezing, itching, nasal swelling,
antihistamines
hives, skin rashes, itchy and watery eyes.

antitussives to relieve or suppress coughing by blocking the cough reflex in the medulla of the brain.

to stimulate bronchial muscles to relax, thereby expanding air passage, resulting in increase
bronchodilators airflow.

to act on the immune system by blocking production of substances that trigger allergic and
corticosteroids
inflammatory actions.
to help clear up congestion. Dilated blood vessels in the nasal and airway membranes are
decongestants
what cause congestion in the nose, sinuses, and chest.
expectorants
to help clear mucus from the airway. Expectorants are prescribed for productive coughs.

9 Everything you need to know about COPD

What is COPD?

Chronic obstructive pulmonary disease, commonly referred to as COPD, is a group of progressive lung
diseases. The most common are emphysema and chronic bronchitis. Many people with COPD have both
of these conditions.
Emphysema slowly destroys air sacs in your lungs, which interferes with outward air flow. Bronchitis
causes inflammation and narrowing of the bronchial tubes, which allows mucus to build up.
The top cause of COPD is tobacco smoking. Long-term exposure to chemical irritants can also lead to
COPD. It’s a disease that usually takes a long time to develop.
Diagnosis usually involves imaging tests, blood tests, and lung function tests.
There’s no cure for COPD, but treatment can help ease symptoms, lower the chance of complications,
and generally improve quality of life. Medications, supplemental oxygen therapy, and surgery are some
forms of treatment.
Untreated, COPD can lead to a faster progression of disease, heart problems, and worsening respiratory
infections.
It’s estimated that about 30 million people in the United States have COPD. As many as half are unaware
that they have it.

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What are the symptoms of COPD?

COPD makes it harder to breathe. Symptoms may be mild at first, beginning with intermittent coughing
and shortness of breath. As it progresses, symptoms can become more constant to where it can become
increasingly difficult to breathe.
You may experience wheezing and tightness in the chest or have excess sputum production. Some people
with COPD have acute exacerbations, which are flare-ups of severe symptoms.
At first, symptoms of COPD can be quite mild. You might mistake them for a cold.

Early symptoms include: • need to clear mucus from your lungs

• occasional shortness of breath, especially
after exercise
• mild but recurrent cough
• needing to clear your throat often,
especially first thing in the morning
You might start making subtle changes, such
as avoiding stairs and skipping physical
activities.
Symptoms can get progressively worse and
harder to ignore. As the lungs become more
damaged, you may experience:
• shortness of breath, after even mild
exercise such as walking up a flight of
stairs
• wheezing, which is a type of higher
pitched noisy breathing, especially during
exhalations
• chest tightness
• chronic cough, with or without mucus
What causes COPD?
every day
• frequent colds, flu, or other respiratory
infections
• lack of energy
In later stages of COPD, symptoms may also
include:
• fatigue
• swelling of the feet, ankles, or legs
• weight loss
Immediate medical care is needed if:
• you have bluish or gray fingernails or lips,
as this indicates low oxygen levels in your
blood
• you have trouble catching your breath or
cannot talk
• you feel confused, muddled, or faint
• your heart is racing
Symptoms are likely to be much worse if you
currently smoke or are regularly exposed to
secondhand smoke.

In developed countries like the United States, the single biggest cause of COPD is cigarette smoking.
About 90 percent of people who have COPD are smokers or former smokers.
Among long-time smokers, 20 to 30 percent develop COPD. Many others develop lung conditions or have
reduced lung function.
Most people with COPD are at least 40 years old and have at least some history of smoking. The longer
and more tobacco products you smoke, the greater your risk of COPD is. In addition to cigarette smoke,
cigar smoke, pipe smoke, and secondhand smoke can cause COPD.
Your risk of COPD is even greater if you have asthma and smoke.
You can also develop COPD if you’re exposed to chemicals and fumes in the workplace. Long-term
exposure to air pollution and inhaling dust can also cause COPD.
In developing countries, along with tobacco smoke, homes are often poorly ventilated, forcing families to
breathe fumes from burning fuel used for cooking and heating.
There may be a genetic predisposition to developing COPD. Up to an estimated 5 percent of people with
COPD have a deficiency in a protein called alpha-1-antitrypsin. This deficiency causes the lungs to
deteriorate and also can affect the liver. There may be other associated genetic factors at play as well.
COPD isn’t contagious.

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Diagnosing COPD

There’s no single test for COPD. Diagnosis is based on symptoms, a physical exam, and diagnostic test
results.
When you visit the doctor, be sure to mention all of your symptoms. Tell your doctor if:
• you’re a smoker or have smoked in the past
• you’re exposed to lung irritants on the job
• you’re exposed to a lot of secondhand smoke
• you have a family history of COPD
• you have asthma or other respiratory conditions
• you take over-the-counter or prescription medications
During the physical exam, your doctor will use a stethoscope to listen to your lungs as you breathe. Based
on all this information, your doctor may order some of these tests to get a more complete picture:
• Spirometry is a noninvasive test to assess lung function. During the test, you’ll take a deep breath
and then blow into a tube connected to the spirometer.
• Imaging tests include a chest X-ray or CT scan. These images can provide a detailed look at your
lungs, blood vessels, and heart.
• An arterial blood gas test involves taking a blood sample from an artery to measure your blood
oxygen, carbon dioxide, and other important levels.
These tests can help determine if you have COPD or a different condition, such as asthma, a restrictive
lung disease, or heart failure.

What are the stages of COPD?

One measure of COPD is achieved by spirometry grading. There are different grading systems, and one
grading system is part of the GOLD classification. The GOLD classification is used for determining COPD
severity and helping to form a prognosis and treatment plan.
There are four GOLD grades based on spirometry testing:

• grade 1: mild • grade 3: severe

• grade 2: moderate • grade 4: very severe

This is based on the spirometry test result of your FEV1. This is the amount of air you can breathe out of
the lungs in the first one second of a forced expiration. The severity increases as your FEV1 decreases.
The GOLD classification also takes into account your individual symptoms and history of acute
exacerbations. Based on this information, your doctor can assign a letter group to you to help define your
COPD grade.

As the disease progresses, you’re more susceptible to complications, such as:

• respiratory infections, including common colds, flu, and pneumonia
• heart problems
• high blood pressure in lung arteries (pulmonary hypertension)
• lung cancer
• depression and anxiety

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10 Spirometry

What is spirometry?

Spirometry is a standard test doctors use to measure how well your lungs are functioning. The test
works by measuring airflow into and out of your lungs.
To take a spirometry test, you sit and breathe into a small machine called a spirometer. This medical
device records the amount of air you breathe in and out and the speed of your breath.

Spirometry tests are used to diagnose these conditions:

• COPD
• Asthma
• Restrictive lung disease (such as interstitial pulmonary fibrosis)
• Other disorders affecting lung function
They also allow your doctor to monitor chronic lung conditions to check that your current treatment is
improving your breathing.
Spirometry is often done as part of a group of tests known as pulmonary function tests.

Spirometry procedure

A spirometry test usually takes about 15 minutes and generally happens in your doctor’s office. Here’s
what happens during a spirometry procedure:

1. You’ll be seated in a chair in an exam room at your doctor’s office. Your doctor or a nurse places a clip
on your nose to keep both nostrils closed. They also place a cup-like breathing mask around your
mouth.
2. Your doctor or nurse next instructs you to take a deep breath in, hold your breath for a few seconds,
and then exhale as hard as you can into the breathing mask.
3. You’ll repeat this test at least three times to make sure that your results are consistent. Your doctor
or nurse may have you repeat the test more times if there is a lot of variation between your test
results. They’ll take the highest value from three close test readings and use it as your final result.

If you have evidence of a breathing disorder, your doctor might then give you an inhaled medication
known as a bronchodilator to open up your lungs after the first round of tests. They’ll then ask you to
wait 15 minutes before doing another set of measurements. Afterward, your doctor will compare the
results of the two measurements to see whether the bronchodilator helped increase your airflow.
When used to monitor breathing disorders, a spirometry test is typically done once a year to once every
two years to monitor changes in breathing in people with well-controlled COPD or asthma. Those with
more severe breathing problems or breathing problems that aren’t well controlled are advised to have
more frequent spirometry tests.

Spirometry measures two key factors: expiratory forced vital capacity (FVC) and forced expiratory
volume in one second (FEV1). Your doctor also looks at these as a combined number known as the
FEV1/FVC ratio. If you have obstructed airways, the amount of air you’re able to quickly blow out of your
lungs will be reduced. This translates to a lower FEV1 and FEV1/FVC ratio.

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How to take a lung function test
Nurse/Doctor: Okay, how old are you?
Patient: Twenty seven.
Nurse/Doctor: How tall are you?
Patient: 154cm.
Nurse/Doctor: Do you smoke, or have you ever
smoked?
Patient: No.
Nurse/Doctor: Do you suffer from asthma?
Patient: No.
Nurse/Doctor: At first, you take this nose clip,
then I will give you this device. You take it like
this. You will inhale to the maximum, then you
take the mouthpiece to the mouth, then you will
exhale completely.
There are two important aspects: firstly you
have to exhale as fast as possible in the first
second, and secondly you have to exhale
completely, so that you make sure to get all the
air out of your lungs. Okay?
Patient: Mm-hmm.
Nurse/Doctor: I will support you with this, I will
tell you when to stop and we will approximately
have to do it three times.
Okay. So put on the nose clip please.
Okay, here we go.
Okay?
Patient: Yes.
Nurse/Doctor: Okay, keep going, keep going...
perfect!
Okay, could you focus on inhaling a little more if
possible? And on the other side, exhaling a little
longer?
Patient: Right.
30
Nurse/Doctor: Okay. Do you want to have a little
break?
Patient: Yes.
Nurse/Doctor: Okay. So are you ready?
Patient: Yes.
Nurse/Doctor: Perfect.
Okay. Let's have another try and as I said before
try to focus on inhaling completely, and exhaling
to the maximum.
Okay, here we go.
Keep going, keep going, keep going… Okay!
Patient: It is hard to keep breathing towards the
end!
Nurse/Doctor: Yes but this was a nice try.
Maybe we will have one or two more and then
we are ready.
Patient: Okay.
Nurse/Doctor: Just relax a little and tell me when
you are ready.
Ready?
Patient: Mm-hm.
Nurse/Doctor: Okay so once again.
Keep going, keep going, keep going...
Okay.
Okay when looking through your lung function
tests, we firstly look at this FVC value which
shows us the total capacity of your lungs. The
second parameter we look at is the FEV-1, FVC
value. This shows us a potential obstruction of
your airways, your large airways. Literally you
got precisely 100%, so you got a really nice lung
function testing.
Okay. Congratulations.
Patient: Thank you.
 4
11 Medical equipment

(1) (2) (3)

(4) (5) (6)

(7) (8) (9)

(10) (11) (12)

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(1) Sputum aspirator: a device for removing sputum by suction.

(2) Swabs: an absorbent pad or piece of material used for cleaning wounds, applying medication, or taking
specimens.

(3) Ventilator: a machine that helps people breathe correctly by allowing air to flow in and out of their
lungs.

(4) Nebulizer: a device for producing a fine spray of liquid, used for inhaling a medication.

(5) Spirometer: an instrument for measuring the air capacity of the lungs.

(6) Inhaler: a small device you use to breathe in particular medicines.

(7) Nasal cannula: a device including two prongs that go inside the nostrils used to deliver supplemental
oxygen or increased airflow.

(8) Endotracheal tube: a small usually plastic tube inserted into the trachea through the mouth or nose to
maintain an unobstructed passageway especially to deliver oxygen or anesthesia to the lungs.

(9)Tracheostomy tube: A small metal or plastic tube that keeps the stoma (opening) and the trachea in a
tracheostomy open.

(10) Bronchoscope: a thin flexible tube for inspecting the bronchi.

(11) Oxygen mask: a mask placed over the nose and mouth and connected to a supply of oxygen.

(12)Bag valve mask: a hand-held device commonly used to provide positive pressure ventilation to
patients.

GLOSSARY

32
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33
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1
Cardiovascular System

The Anatomy of Cardiovascular System

2 Introduction of Cardiovascular System

The cells of the body are dependent on a There are three types of blood vessels in the
constant supply of nutrients and oxygen. body: arteries, veins, and capillaries.
When this is delivered to the cells and Arteries are the large blood vessels that are
chemically combined they release the energy responsible for carrying blood away from the
necessary to do the work of each cell. The heart. The walls of the arteries are lined with
cardiovascular system which consists of the connective tissue, muscle tissue, and elastic
heart and blood vessels, performs all of this fibers. The innermost layer of epithelial cells is
important work. called the endothelium.
Smaller branches of arteries are called
arterioles and are thinner than arteries and
carry the blood the tiniest blood vessels called
capillaries. Capillaries have walls that are only
one endothelial cell in thickness and they are
responsible for carrying nutrient-rich,
oxygenated blood from the arteries and
arterioles to the cells of the body.

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The waste products such as carbon dioxide and
water pass out of the cells and into the thin-
walled capillaries. This waste-filled blood then
flows back to the heart in the venules which
combine to make larger vessels called veins.
Veins conduct the blood toward the heart from
the tissues.

Air is then allowed to escape from the bag and

the pressure is slowly lowered. This allows the
blood to being to make its way through the
gradually opening artery.
At the point when the person listening with the
stethoscope first hears the sound of the pulse
beats, the reading on the device attached to the
Blood pressure is the force the blood exerts on
cuff shows the systolic blood pressure (higher
the arterial walls. Blood pressure is measured
pressure).
with a sphygmomanometer which consists of a
As the air continues to escape, the sounds
rubber bag inside a cloth cuff which is wrapped
become louder. Finally, when a change in sound
around the upper arm, just above the elbow.
from loud to soft occurs the observer makes a
The rubber bag is inflated with air using a hand
note of the pressure on the recording device.
bulb pump. When the bag is pumped up, the
This is the diastolic blood pressure.
pressure within it increases and is then
Blood pressure is expressed as a fraction.
measured on a recording device attached to the
For example 120/80 mm Hg.
cuff.
The upper number is the systolic pressure and
The brachial artery in the upper arm is
lower number is the diastolic pressure.
compressed by the air pressure in the bag.
When there is sufficient air pressure in the bag
to stop the flow of blood, the pulse in the lower
arm drops.

35
5
3 Cardiovascular System Terms

Combining Form Meaning Pericarditis: Inflammation of the membrane

surrounding the heart.
angi/o vessel
Rheumatic Heart Disease: Heart disease caused
aort/o aorta by rheumatic fever.
arter/o, arteri/o artery Aneurysm: Local widening of an arterial wall.
yellowish plaque, fatty Deep Vein Thrombosis (DVT): Blood clot forms
ather/o in a large vein, usually in a lower limb.
substance
Hypertension (HTN): High blood pressure
atri/o atrium, upper heart chamber
Varicose Veins: Abnormally swollen and
brachi/o arm
twisted veins, usually occurring in the legs.
cardi/o heart
cholesterol/o cholesterol (a lipid substance) Laboratory Test & Clinical Procedures
coron/o heart
Cardiac Biomarkers: Chemicals are measured in
cyan/o blye
the blood as evidence of a heart attack.
myx/o mucus
Lipid Tests: Measurement of cholesterol and
ox/o oxygen triglycerides (fats) in a blood sample.
pericardi/o pericardium Angiography: X-ray imaging blood vessels
phleb/o vein after injection of contrast material.
rrhythm/o rthythm Doppler Ultrasound Studies: Sound waves
measure blood flow within blood vessels.
sphygm/o pulse
Echocardiography (ECHO): Echoes generated
steth/o chest
by high-frequency sound waves produce
thromb/o clot images of the heart.
valvul/o vessel Cardiac Catheterization: Thin, flexible tube is
vas/o vessel guided into the heart via a vein or an artery.
vascul/o vessel Electrocardiography: Recording of electricity
flowing through the heart.
ven/o, ven/i vein
Stress Test: Exercise tolerance test (ETT)
ventricul/o ventricle, lower heart chamber
determines the heart’s response to physical
exertion.
4 Pathology of Cardiovascular System
Coronary Artery Bypass Grafting
Pathologic Conditions (CABG): Arteries and veins are anastomosed to
coronary arteries to detour around blockages.
Arrhythmias: abnormal heart rhythms. Endarterectomy: Surgical removal of plaque
Bradycardia: Failure of proper conduction of form the inner layer of an artery.
impulses from the SA node through the AV node Percutaneous Coronary Intervention
to the atrioventricular bundle. (PCI): Balloon-tipped catheter is inserted into a
Fibrillation: Very rapid, random, inefficient, and coronary artery to open the artery; stents are
irregular contractions of the heart (350 beats or put in place.
more per minute). Thrombolytic Therapy: Drugs to dissolve clots
Congenital Heart Disease: Abnormalities in the are injected into the bloodstream of patients
heart at birth. with coronary thrombosis.
Endocarditis: Inflammation of the inner lining of Congestive Heart Failure: Heart is unable to
the heart. pump its required amount of blood.
Murmur: Extra heart sound, heard between Coronary Artery Disease: Disease of the
normal beats. arteries surrounding the heart.

36
 5
5 Pharmacology of Drugs acting on Cardiovascular System
Pharmacology

A healthy, functional cardiovascular system ensures adequate blood circulation and efficient delivery of
oxygen and nutrients to all parts of the body. When any part of the cardiovascular system malfunctions
or becomes diseased, drug therapy plays an integral role in establishing and maintaining perfusion and
homeostasis. Medications treat a variety of cardiovascular conditions, including angina pectoris,
myocardial infarction, heart failure (HF), arrhythmias, hypertension, hyperlipidemia, and vascular
disorders. Many cardiovascular drugs treat multiple problems simultaneously.

Drugs Used to Treat Cardiovascular Disorders

Classification Effects
angiotensin-converting to lower blood pressure by inhibiting the converting of angiotensin I to
enzyme (ACE) inhibitors angiotensin II.
angiotensin II receptor
lower blood pressure by blocking the angiotensin II enzyme.
blockers (ARBs)
antiarrhythmics to help treat atrial and ventricular arrhythmias
to inhibit the body natural’s coagulation response to prevent the formation of
anticoagulants
clots in blood vessels.
beta blockers to block the effect of adrenaline, which slows nerve pulses through the heart.
calcium channel blockers to block movement of calcium into myocardial cell and arterial wall.
to dilate bloodvessels of the heart and widen blood vessels of the body, allowing
nitrates
more blood flow to the heart.
statins to lower cholesterol in the blood and reduce its production in the liver.
diuretics to reduce fluid buildup in the body.

6 Electrocardiogram ECG

What is electrocardiogram?

An electrocardiogram is a simple, painless test that measures your heart’s electrical activity. It’s also known
as an ECG or EKG. Every heartbeat is triggered by an electrical signal that starts at the top of your heart
and travels to the bottom. Heart problems often affect the electrical activity of your heart. Your doctor
may recommend an ECG if you’re experiencing symptoms or signs that may suggest a heart problem, such
as chest pain, palpitations (suddenly noticeable heartbeats), dizziness and shortness of breath.

An ECG can help detect:

• Arrhythmias – where the heart beats too slowly, too quickly, or irregularly
• Coronary heart disease – where the heart’s blood supply is blocked or interrupted by a build-up of fatty
substances
• Heart attacks– where the supply of blood to the heart is suddenly blocked
• Cardiomegaly – where the heart walls become thickened or enlarged
• A series of ECGs can also be taken over time to monitor a person already diagnosed with a heart
condition or taking medication known to potentially affect the heart.

37
5
What happens during an electrocardiogram?

An ECG is quick, painless, and harmless. After you change into a gown, a technician attaches 12 to 15 soft
electrodes with a gel to your chest, arms, and legs. The technician may have to shave small areas to ensure
the electrodes stick properly to your skin. Each electrode is about the size of a quarter. These electrodes
are attached to electrical leads (wires), which are then attached to the ECG machine.
During the test, you’ll need to lie still on a table while the machine records your heart’s electrical activity
and places the information on a graph. Make sure to lie as still as possible and breathe normally. You
shouldn’t talk during the test.
After the procedure, the electrodes are removed and discarded. The entire procedure takes about 10
minutes.

7 ECG procedure for kids

Herman: Hi I'm Herman, and welcome to Ask
Hermin.
Eve: Hi,
Herman: Hi, I'm here with my friend Eve.
Hi Eve! I heard you have a question.
Eve: I want to know what an ECG is.
Herman: Oh I know, it's an 'elephant candy
game'.
Eve: No?
Herman: I thought that was it.
Eve: It's okay, we all make mistakes.
Herman: Yeah, I guess so. Is it a test at the
hospital?
Eve: Yeah.
Herman: Maybe I'll go ask the experts.
Eve: Yep, and when you go, you can come back
and tell me what an ECG is.
Herman: Okay, I'll do that.
Eve: Bye
Herman: Hi there, I'm here with my friend Jesse,
who is an ECG tech. How are you?
Jesse: I'm good. How are you?
Herman: Good. We have a couple of questions.
Jesse: Okay.
Herman: What is an ECG?
Jesse: An ECG is an electrocardiogram. It takes a
picture of your heart rate and rhythm.
Herman: Oh I guess Eve and I were kind of close.
Can you tell us a little bit about what happens
when you get an ECG?
Jesse: So when you get an ECG we put these
stickers on your arms, legs and chest. And then
we hook up wires like this and then your picture
shows up on the computer and we take a
picture.
Herman: Oh that sounds interesting. Can I eat one of
those?
Jesse: Do you want to try one on?
Herman: Oh okay, is it fluffy?
Jesse: No, they're sticky.
Herman: Oh it kind of tickles.
Jesse: And are they cold?
Herman: A little bit yeah. And then is it really gentle to
take off?
Jesse: It's a little sticky, but we're pretty good at
taking them off. Like that.
Herman: Oh, that was awesome. Can you show how
an ECG works with a patient?
Jesse: Sure.
Herman: Okay, thanks. Okay Jesse, so how long do
you have to lie down like this for?
Jesse: So you have to lie down like this for the whole
test but you only have to stay still for 10 seconds. The
whole test doesn't take long though.
Herman: Okay and how long does it take to get ready
for the test?
Jesse: Maybe a minute or two?
Herman: Oh that sounds easy. Okay will you show me
how it's done?
Jesse: Sure
Herman: So how many stickers is that?
Jesse: It's 13 in total, one on each arm, one on each leg
and nine go across your chest. And now these attach
to the stickers. So this little clip.
Herman: Oh so they don't even touch your skin.
Jesse: No, they attach to that part. Do you want to try
one?
Herman: Yeah.
Jesse: This one goes right there.
Herman: Easy peasy

38

Jesse: Yep, and now the rest attach. Now that you're
all hooked up you would stay really still for 10
seconds.
Herman: One, two, three, four, five, six, seven, eight,
nine, ten.
Jesse: And we would take the picture, and that's it!
Herman: All done.
Jesse: Done! And then we would take these off and
then we would take the stickers off.
Herman: You did a good job. Ah, Jesse?
5
Jesse: Yeah? Oh, what did you do?
Herman: I was just trying to be an ECG tech
Jesse: You have stickers everywhere.
Herman: Yeah, it was kind of fun. Do you think I
would get the job?
Jesse: No, I think we need to take those stickers
off.
Herman: Okay well I'll leave it to the experts.
Thanks for your time.
Jesse: No problem.
Herman: Thanks Eve for the question. Bye!

8 Medical equipment

(1) (2) (3)

(4) (6)
(5)

(7) (8) (9)

39
5
(1) Cardiac ultrasound machine: a device uses sound waves to produce images of the heart in
echocardiography.

(2) Stethoscope: a piece of medical equipment that doctors use to listen to the heart and lungs.

(3) Heart rate monitors: a device that can detect the heartbeat, count the beats per minute and then
display it.

(4) Treadmills: a device having an endless belt on which an individual walks or runs in place for exercise or
physiological testing.

(5) Wheelchair: a chair on wheels that people who are unable to walk use for moving around.

(6) Crutch: a long stick with a crosspiece at the top, used as a support under the armpit by a lame person.

(7) ECG machine: A device records the electrical activity of the heart in electrocardiography.

(8) Cardiac pacemaker: a small device that's placed in the chest or abdomen to help control abnormal
heart rhythms.

(9) Defibrillator: an electronic device that applies an electric shock to restore the rhythm of a fibrillating
heart.

GLOSSARY

40
 1 Introduction to vital signs
Vital signs
6
What are vital signs?

Vital signs are measurements of the body's most basic functions. The 5 main vital signs routinely checked
by healthcare providers include:

• Body temperature
• Pulse rate
• Breathing rate (respiration)
• Oxygen saturation
• Blood pressure

Vital signs help detect or monitor medical problems. They can be measured in a medical setting, at home,
at the site of a medical emergency, or elsewhere.

What is body temperature?

The normal body temperature of a person varies

depending on gender, recent activity, food and 37 ℃
fluid consumption, time of day, and, in women, 35 ℃
the stage of the menstrual cycle. Normal body 33 ℃
temperature can range from 97.8° F (36.5°C) to 31 ℃

99°F (37.2°C) for a healthy adult. Body 29 ℃

temperature may be abnormal due to fever 27 ℃

(high temperature) or hypothermia (low

temperature). A fever is indicated when body
temperature rises about 1 degree or more over
the normal temperature of 98.6°F. Hypothermia
is defined as a drop in body temperature below
95°F.
Cold Warm
What is the pulse rate?

The pulse rate is a measurement of the heart

rate. This is the number of times the heart beats
per minute. As the heart pushes blood through
the arteries, the arteries expand and contract
with the flow of the blood. Taking a pulse not
only measures the heart rate, but also can
indicate the following:
• Heart rhythm
• Strength of the pulse
The normal pulse for healthy adults ranges from
60 to 100 beats per minute. The pulse rate may
fluctuate and increase with exercise, illness,
injury, and emotions. Females ages 12 and older,
in general, tend to have faster heart rates than
do males. Athletes, such as runners, who do a lot
of cardiovascular conditioning, may have heart
rates near 40 beats per minute with no
problems.

41
6
What is the respiration rate?

The respiration rate is the number of breaths

you take each minute. The rate is usually
measured when you are at rest. It simply
involves counting the number of breaths for
one minute by counting how many times your
chest rises. Respiration rates may increase with
exercise, fever, illness, and with other medical
conditions. When checking respiration, it's
important to also note whether you have any
trouble breathing.
Normal respiration rates for an adult person at
rest range from 12 to 20 breaths per minute.

What is oxygen saturation?

Oxygen saturation is the fraction of oxygen-

saturated hemoglobin relative to total
hemoglobin (unsaturated + saturated) in the
blood. The human body requires and regulates a
very precise and specific balance of oxygen in
the blood. Normal arterial blood oxygen
saturation levels in humans are 95–100 percent.
What is blood pressure?
If the level is below 90 percent, it is considered
low and called hypoxemia. Arterial blood oxygen
Blood pressure is the force of the blood pushing
levels below 80 percent may compromise organ
against the artery walls during contraction and
function, such as the brain and heart, and
relaxation of the heart. Each time the heart
should be promptly addressed. Continued low
beats, it pumps blood into the arteries. It results
oxygen levels may lead to respiratory or cardiac
in the highest blood pressure as the heart
arrest.
contracts. When the heart relaxes, the blood
pressure falls.
Two numbers are recorded when measuring
blood pressure. The higher number is called
systolic pressure. It refers to the pressure inside
the artery when the heart contracts and pumps
blood through the body. The lower number is
called diastolic pressure. It refers to the pressure
inside the artery when the heart is at rest and is
filling with blood. Both pressures are recorded
as "mm Hg" (millimeters of mercury).
High blood pressure directly increases the risk
of heart attack, heart failure, and stroke. With
high blood pressure, the arteries may have an
increased resistance against the flow of blood.
This causes the heart to work harder to circulate
the blood.

42

Abbreviations and normal ranges of vital signs
Vital signs Abbreviation
Temperature T/temp
Heart rate/ Pulse rate HR/PR
Respiratory rate RR
Oxygen saturation SpO2
Blood pressure BP
2 Disorders related to vital signs
Temperature
Febrile: having or showing an elevation of body
temperature above the normal temperature of
98.6 degrees F, or 37 degrees C. A person
develops a fever (a noun) and is described as
febrile (an adjective).
Hypothermia: a body temperature below 95
degrees F. or 35 degrees C. Hypothermia may be
induced by exposure to cold, failure of body
mechanisms to control heat loss.
Hyperthermia: the prolonged elevation of body
temperature to above normal. For example,
prolonged elevation to 100-101 degrees
Fahrenheit or 37.5-38.3 degrees C is usually due
to prolonged exposure to heat. Also referred to
as heat exhaustion or heat stroke.
Oxygen saturation
Normoxia: the condition of having a normal
level of oxygen.
Hypoxia: deficiency in the amount of oxygen
reaching the tissues. Hypoxemia can cause
hypoxia when blood doesn't carry enough
oxygen to the tissues to meet the body's
needs.
43
6
Normal ranges
97.8°F (36.5°C) – 99°F (37.2°C)
60 – 100 beats per minute
12 to 20 breaths per minute
95 – 100%
Systolic BP: 90 – 119
Diastolic BP: 60 – 79
Pulse
Arrhythmia: An arrhythmia is a problem with the
rate or rhythm of your heartbeat. It means that
your heart beats too quickly, too slowly, or with
an irregular pattern.
• Bradycardia: when the heart beats too slowly.
• Tachycardia: when the heart beats faster than
normal.
• Ventricular fibrillation (VF or VFib): a heart
rhythm problem that occurs when the heart
beats with rapid, erratic electrical impulses.
This causes the ventricles to quiver uselessly
instead of pumping blood.
• Atrial fibrillation (AF or AFib): an abnormal
heart rhythm characterized by the rapid and
irregular beating of the atria. This causes the
atria to quiver uselessly instead of pumping
blood into the ventricles.
Hypoxemia: a below-normal level of oxygen in
your blood, specifically in the arteries.
Anoxia: an absence or deficiency of oxygen
reaching the tissues; severe hypoxia.
6
Respiratory rate
Blood pressure

Eupnea: normal, good, unlabored breathing,

Hypertension (HTN): A disease where blood
sometimes known as quiet breathing or resting
pressure is elevated. Typically, a systolic
respiratory rate.
measurement over 140 or a diastolic
measurement over 90 is considered
Bradypnea: an abnormally slow breathing rate
hypertension.
(less than 12 breaths per minute in adult
humans at rest).
Hypotension: Occurs when the systolic blood
pressure is below 90 and the diastolic blood
Tachypnea: an abnormally rapid breathing rate
pressure is below 60. A particular kind of
(greater than 20 breaths per minute in adult
hypotension related to body position or posture
humans at rest).
is known as Orthostatic Hypotension.

Dyspnea: difficult or labored breathing, also

Orthostatic Hypotension: The lowering of blood
known as Shortness of Breath (SOB).
pressure when a patient moves from
recumbent (lying down) position to standing
Apnea: a medical condition that makes
(erect) position. This is also termed Postural
someone stop breathing for a short time,
Hypotension.
especially when they are sleeping.

3 Vital signs measurement

Before beginning your skill, always make sure

that you wash your hands. The next set of skills
is temperature, pulse and respirations and
taking a blood pressure. The supplies that you'll
need are an electronic thermometer, a
temperature sheath, a manual blood pressure
cuff, stethoscope, alcohol and cotton balls.

Mari: Hi Beth. My name is Mari. I'm going to be

your aid today. How are you?
Beth: I’m good.
Mari: I'm here to check your vital signs, okay?
Beth: Okay.

The first thing I'm going to do is raise the bed up
to a good working level for me. We need to
raise the head of the bed.
Mari: First I'm going to check your temperature.
I'm going to clean the thermometer with a small
amount of alcohol and a cotton ball. The
thermometer goes in the plastic sheath between
the two plastic pieces. I'm going to turn the
thermometer on and wait for it to say it's ready.
The thermometer goes under the tongue and in
the back of the mouth.
Mari: Your temperature is 98.6 (ninety eight
point six), Beth.
I'll take the thermometer sheath off and place it
in the trash can.
Mari: The next thing I'm going to do is check
your pulse and respirations.
I’m going to use the first three fingers on my
left hand and I'm going to hold her wrist so that
I can feel where the pulse is.

44

Mari: All right your pulse is 82 in your
respiratory rate is 20, Beth. I did not tell you
that I was checking your respiratory rate
because I didn't want you to change the way
you were breathing for me. All right. The next
thing that I'm going to do is obtain your blood
pressure.
I'm going to place the blood pressure cuff above
the crease in the arm with the marking over the
inside part of the arm. I want to make sure that
this blood pressure cuff is snug and secure. I'm
going to use the stethoscope and the first thing
I want to do is clean the earpieces with an
alcohol wipe and the head of the stethoscope.
The stethoscope is placed on the inner part of
the arm along the crease so that it's over the
artery. I'm going to pump the blood pressure
cuff up to approximately 180 millimeters of
mercury and listen carefully. I slowly released
the air from the blood-pressure cuff listening
for the thudding sound.
Mari: 138 over 84, Beth.
4 Medical equipment
(1) (2)
(6) (7)
6
I'll remove the blood pressure cuff from her arm
and set it aside. Before using the stethoscope,
it's always a good idea to make sure that the
earpieces are pointed forward towards your
nose and that you check to make sure that the
head of the stethoscope is on the right side.
Now I will clean up the rest of my supplies and
make sure that I've repositioned Beth for
comfort.
The head of the bed should be at 30 degrees.
The side rails will be up if they're ordered.
Returning the bed to the low position and
making sure that Beth has her call light in reach.
Mari: Are you comfortable, Beth?
Beth: I am.
Mari: All right. Thank you.
Beth: Thank you.
At the end of the skill, record and report.
(3) (4) (5)
(8) (9)
45
6
(1) Vital signs monitor: The most basic monitor shows your heart rate, blood pressure, and body
temperature, how much oxygen your blood is carrying and how fast you're breathing.

(2) Pulse oximeter: a device that measures your oxygen saturation level, or the oxygen levels in your blood.

Thermometer: a device used for measuring temperature

(3) Infrared thermometer: also called a forehead thermometer, a thermometer that use electromagnetic
radiation to make non-contact surface temperature readings.

(4) Mercury thermometer: a thermometer consisting of mercury contained in a bulb at the bottom of a
graduated sealed glass capillary tube marked in degrees Celsius or Fahrenheit.

(5) Digital thermometer: Digital thermometers are temperature-sensing instruments that are easily
portable, have permanent probes, and a convenient digital display.

Heart rate monitor: A wearable device that allows a user to measure their heart rate in real time, usually
consisting of a chest strap transmitter and a wrist receiver.

(6) Chest strap: Electrode sensors in a chest strap detect each heartbeat and transmit the data to a
receiver display such as a watch, fitness wearable, or phone app.

(7) Smart watch: a wearable device that measures heart rate by scanning blood flow near your wrist.

Sphygmomanometer: an instrument for measuring blood pressure and especially arterial blood pressure.

(8) Blood pressure cuff: a sphygmomanometer consists of an inflatable cuff to collapse and then release
the artery under the cuff in a controlled manner, and a mercury or aneroid manometer to measure the
pressure.

(9) Digital BP monitor: A digital device has a cuff that wraps around your arm, a button to inflate the cuff
automatically and a screen to show a digital readout of your systolic and diastolic blood pressure.

GLOSSARY

46
 6

47
7 Blood Stream

1 Introduction to Blood System

The primary function of blood is to maintain a

constant environment for the other living tissues
in the body. Blood is responsible for transporting
nutrients, gases, and wastes to and from the
cells of the body. Nutrients from food digested
in the stomach and small intestine pass into the
bloodstream to be carried to all body cells.
Red blood cells transport oxygen from the lungs
to the cells throughout the body. Blood also
helps remove waste products released by cells
by carrying chemical waste to the kidneys to be
excreted in the urine. Blood transports
hormones from their sites of secretion in glands
to distant sites where they regulate growth,
reproduction, and energy production.

Blood components

Finally, blood contains proteins, white blood

cells, and antibodies that fight infections, and
platelets and other proteins that help the
Plasma
blood to clot. Blood is made up of cells that
are suspended in a clear, straw-colored liquid
called plasma.
White Blood Cells & Platelets Cells normally make up 45% of the blood
volume and include erythrocytes or red blood
cells, leukocytes or white blood cells, and
Red Blood Cells platelets or thrombocytes which are clotting
cells.
The other 55% of blood is plasma. Plasma is a
solution of water, proteins, sugar, salts,
hormones, lipids, and vitamins.

Starting at birth, all blood cells originate in the

marrow cavity of bones. Both red and white
blood cells arise from hematopoietic stem cells.
With the influence of proteins and blood in the
bone marrow, the stem cells change their size
and shape to become specialized or
differentiated.

48
 7
2 Blood System Laboratory Test and Clinical Procedures

Term Definition
Coagulation Time Time required for venous blood to clot in a test tube.

Determination of numbers of blood cells, hemoglobin concentration,

Complete Blood Count (CBC)
hematocrit, and red cell values.
Hematocrit (Hct) Percentage of erythrocytes in a volume of blood.
Hemoglobin Test Total amount of hemoglobin in a sample of peripheral blood.
Platelet Count Number of platelets per cubic millimeter or microliter of blood.
Prothrombin Time (PT) Test of the ability of blood to clot.
White Blood Cell Count
Number of leukocytes per cubic millimeter or microliter of blood.
(WBC)
White Blood Cell Differential Percentages of different types of leukocytes in the blood.
Blood Transfusion Whole blood or cells are taken from a donor and infused into a patient.
Bone Marrow Biopsy Microscopic examination of a core of bone marrow removed with a needle.
Hematopoietic Stem Cell
Peripheral stem cells from a compatible donor are administered to a recipient.
Transplantation

3 Blood System Pathology

Term Definition
Anemia Deficiency in erythrocytes or hemoglobin.
Hemochromatosis Excess iron deposits throughout the body.

Exessive bleeding caused by hereditary lack of factor VII and IX necessary for blood
Hemophilia
cloting.
Leukemia increase in cancerous while blood cells (leukocytes).
Multiple Myeloma Malignant neoplasm of bone marrow.

4 Blood System Terms

suffixes Meaning suffixes Meaning

-apheresis removal, acarrying away -oid derived or originating form
-blast immature or embryonic cell -osis abnormal condition
abnormal condition of cells
-cytosis -penia deficiency
(increase in cells)

-emia blood condition -phage eat, swallow

-gen giving rise to; producing -philia attraction for

-blobin protein -phoresis carrying, transmission

-lytic pertaining to destruction -poiesis formation

-stasis stop, control

49
7
Combining Form Meaning Combining Form Meaning

bas/o base leuk/o white

chrom/o color mon/o one, single

coagul/o clotting morph/o shape, form

cyt/o cell myel/o bone marrow

eosin/o red, dawn, rosy neutr/o neutral

erythr/o red nucle/o nucleus

granul/o granules phag/o eat, swallow

hem/o; hemat/o blood poikil/o varied, irregular

hemoglobin/o hemoglobin sider/o iron

is/o same, equal spher/o globe, round

kary/o mucleus thromb/o clot

5 Pharmacology of drugs acting on Blood, Lymphatic, and Immune System

Various pharmaceutical agents are available to treat blood, lymphatic, and immune system disorders.
These drugs act directly on individual components of each system. For example, anticoagulants help
prevent clot formation but are ineffective in destroying formed clots. Instead, thrombolytics help dissolve
clots that obstruct coronary, cerebral, or pulmonary arteries. Conversely, hemostatics help prevent or
control hemorrhage. In addition, chemotherapy and radiation are common treatments for diseases of the
blood and immune system. For example, antineoplastics prevent cellular replication to halt the spread of
cancer in the body; antiretrovirals prevent viral replication within cells and have been effective in slowing
the progression of HIV and AIDS.

Drugs Used to Treat Blood, Lymphatic, and Immune Disorders

Classification Effects
to prevent blood clot formation and to prevent deep vein thrombosis (DVT) and
anticoagulants
postoperative clot formation and decrease the risk stroke.
to treat serious bleedingfollowing certain surgeries and dental procedures, especially
antifibrinolytics
in patients with heophilia.
to destroy bacteria, fungi, and protozoa, depending on the particular drug, generally
antimicrobials
by interfering with the functions of he cell membrane or the reproductive cycle.
antiretrovirals to prevent replication of viruses within host cells.

immunosuppressants to decrease inflamation by supressing the body’s natural immune response.

thrombolytics to dissvole blood clots by destroying their firbrin strands.

50
 7
6 Understanding Anemia - Symptoms

What Are the Symptoms of Anemia?

The symptoms of anemia vary according to the type of anemia, the underlying cause, the severity and
any underlying health problems, such as hemorrhaging, ulcers, menstrual problems, or cancer. Specific
symptoms of those problems may be noticed first.
The body also has a remarkable ability to compensate for early anemia. If your anemia is mild or has
developed over a long period of time, you may not notice any symptoms.

Symptoms common to many types of anemia Anemia Caused by Chronic Lead Poisoning
include the following: Chronic lead poisoning may lead to these
• Easy fatigue and loss of energy symptoms:
• Unusually rapid heart beat, particularly with • A blue-black line on the gums referred to as
exercise a lead line
• Shortness of breath and headache, • Abdominal pain
particularly with exercise • Constipation
• Difficulty concentrating • Vomiting
• Dizziness
• Pale skin Anemia Caused by Chronic Red Blood Cell
• Leg cramps Destruction
• Insomnia Anemia caused by chronic red blood cell
Other symptoms are associated with specific destruction may include these symptoms:
forms of anemia. • Jaundice (yellow skin and eyes)
• Brown or red urine
Anemia Caused by Iron Deficiency • Leg ulcers
People with an iron deficiency may experience • Failure to thrive in infancy
these symptoms: • Symptoms of gallstones
• A hunger for strange substances such as
paper, ice, or dirt (a condition called pica) Sickle Cell Anemia
• Upward curvature of the nails, referred to as Symptoms of sickle cell anemia may include:
koilonychias • Fatigue
• Soreness of the mouth with cracks at the • Susceptibility to infection
corners • Delayed growth and development in children
• Episodes of severe pain, especially in the
Anemia Caused by Vitamin B12 Deficiency joints, abdomen, and limbs
People whose anemia is caused by a deficiency
of Vitamin B12 may have these symptoms: Anemia Caused by Sudden Red Blood Cell
• A tingling, "pins and needles" sensation in Destruction
the hands or feet Symptoms of anemia caused by sudden red
• Lost sense of touch blood cell destruction may include:
• A wobbly gait and difficulty walking • Abdominal pain
• Clumsiness and stiffness of the arms and • Brown or red urine
legs • Jaundice (yellow skin)
• Dementia • Small bruises under the skin
• Seizures
• Symptoms of kidney failure

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7
Call Your Doctor About Anemia If:

Talk to your doctor if you have risk factors for anemia or notice any signs or symptoms of anemia
including:
• Persistent fatigue, breathlessness, rapid heart rate, pale skin, or any other symptoms of anemia; seek
emergency care for any trouble breathing or
• change in your heart beat.
• Poor diet or inadequate dietary intake of vitamins and minerals
• Very heavy menstrual periods
• Symptoms of an ulcer, gastritis, hemorrhoids, bloody or tarry stools, or colorectal cancer
• Concern about environmental exposure to lead
• A hereditary anemia runs in your family and you would like genetic counseling before having a child

For women considering pregnancy, your doctor will likely recommend that you begin taking
supplements, especially folate, even before conception. These supplements benefit both mother and
baby.

7 Intravenous cannulation (IV) performance

Wash hands

Introduce yourself
Andrew: Hi there, I am Andrew. One of the
medical students.

Confirm patient details

Andrew: Can I confirm your name and date of IV cannulation
birth, please? • Clean tray
James: Sure, it's James, 13 December 1989. • Gather equipment: cannula dressing, alcohol
Andrew: Nice to meet you, James. swab, pre-filled saline flush, gauze,
tourniquet, cannula, extension set, gloves,
Explain procedure field.
Andrew: Today I've been asked to insert a • Don apron
cannula into your arm. It's a small plastic tube • Don gloves
which will allow us to give fluids and • Set up equipment on field
medications. • Prepare saline flush (prime extension set)
• Position patient’s arm
Gain consent • Inspect for a suitable vein
Andrew: It might be a bit uncomfortable but it • Apply tourniquet
won't be painful. Is that OK? Andrew: If you just lift your arm for me, James.
James: Yes it is. • Palpate the vein
Andrew: Brilliant. Are you allergic to anything at • Clean the site for 30 seconds (allow to dry)
all? • Wash hands
James: No. • Don gloves
Andrew: Fantastic. I will just gather my • Prepare cannula
equipment and then we’ll begin. • Secure the vein from below

52
 7
Andrew: James, I'm just going to flush the
Andrew: OK James. Sharp scratch.
cannula now. Do let me know if there is any
• Insert cannula at 10 - 30 degrees
pain.
• Observe flashback
• Apply cannula dressing
• Withdraw introducer needle
• Label with date of insertion
• Advance cannula into vein
• Remove gloves
• Remove tourniquet
• Remove apron and dispose of all clinical
• Remove the introducer needle
waste appropriately
• Dispose of sharp
• Wash hands
• Attach extension set (or replace cap)
Andrew: Thank you, James. We are all done. Are
• Secure the cannula
you feeling OK?
James: Yes, I am. Thank you.
Andrew: OK. Brilliant. Thank you.

8 Medical equipment

(1) (2) (3) (4)

(5) (6) (7) (8)

(9) (10) (11) (12)

53
7
(1) Syringe: a small tube with a thin hollow needle at the end used for collecting blood or other liquids or
for putting liquids into the body.

(2) Butterfly needle: a needle used to access a vein for drawing blood or giving medications for a short
time. There are plastic “wings” on either side of the hollow needle.

(3) cannula: A small, flexible tube inserted into a vein to administer fluids or medications for a longer time.
It can stay in the body from 72 to 96 hours.

(4) Cannula dressing: a sterile tape to secure the cannula, keep the cannula in the vein, and to cover the
insertion site so that it is kept dry and clean and protected from infection.

(5) Extension set: a tube connects to the IV cannula to allow a larger distance between the patient and the
fluid being administered.

(6) Cotton ball: a small ball of cotton used to stop or prevent bleeding from minor punctures such as
injections or venipuncture.

(7) Gauze: a loosely woven, almost translucent fabric that's used to bandage wounds.

(8) Alcohol swab: a small piece of cloth which is soaked in alcohol and used to clean skin before an
injection.

(9) Medical tape: a type of adhesive tapes used in medicine and first aid to hold a bandage or other
dressing onto a wound.

(10) Tourniquet: : A bandage applies pressure to a limb by twisting tightly, used to control bleeding.

(11) Blood collection tube: a sterile glass or plastic test tube with a colored rubber stopper used for containing
blood specimens.

(12) Saline: A solution of salt (sodium chloride) in water with the same concentration of salt as body fluids and
is suitable for infusion into a vein.

GLOSSARY

54
 7

55
8 Pharmacology

1 Introduction to Pharmacology

Drugs or medicines are substances used to prevent or treat a disease or conditions. Some of these drugs
are obtained from plants such as the roots, leaves, and fruit. Other drugs are derived from molds or
obtained from animals. Virtually all drugs are synthesized for commercial purposes in a laboratory.
Vitamins are drugs that are isolated from plant or animal sources and are contained in foods. There are
various methods for the administration of drugs.

Oral administration is when drugs are given by

mouth. They are slowly absorbed into the
bloodstream through the stomach or intestinal
wall.

Sublingual Administration is when the drugs

are placed under the tongue to dissolve into
the saliva.

Rectal administration is when drugs are given by

suppositories and aqueous solutions inserted in
the rectum.

Inhalation is when vapors or gases are taken

into the nose or mouth and are absorbed into
the bloodstream through the thin wall of air
sacs in the lungs.

Topical application is when drugs are applied

locally on the skin or mucous membranes of the
body.

56
 8
Parenteral administration is the injection of drugs from a syringe through a hollow needle placed under
the skin into a muscle, vein, or body cavity.

o Intramuscular o Intravenous

o Intradermal o Subcutaneous

2 Pharmaceutical Formulations

Pharmaceutical formulation is defined as the process in which different chemical substances are
combined to produce a final medicinal product. The formulation studies involve developing a preparation
of drug acceptable for patient. Formulation is the word often used in a way that includes dosage form.

Liquid dosage forms are essential
pharmaceutical products which involves a
mixture of active drug components and
nondrug components (excipients). Liquid
dosage forms are prepared: a) by dissolving
the active drug substance in an aqueous or
non- aqueous (e.g. glycerin, ether, alcohol)
solvent b) By suspending the drug in
appropriate medium or c) By incorporating the
drug substance into an oil or water phase. Ex:
Suspension, Emulsion, Syrups, Elixers.
Semi-solid dosage forms are the products
when applied to the skin treat a pathological
condition and protects from other harmful
environment. They are smooth, non-staining
and get miscible with skin secretions. Creams,
Gels, Pastes etc. are the examples.
Solid dosage formulations are important dosage
forms in pharmaceuticals .e.g. tablets, capsules,
granules, sachets, reconstitutable powders,
powders, dry powder inhalers and chewables.
Solid dosage form contains unit dose of one or
more medicament. Excipients include Binders,
Glidants, Sweeteners etc.,
Gaseous dosage forms are packed in a container
which gets released upon applying pressure.
The gas inside contains therapeutically active
medicaments. The containers have valve
systems with continuous or limited delivery.
They are used for topical application on skin and
as local application into nose and mouth.

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8
3 Abbreviations of Drug Use

Abbreviations related to administrations Abbreviations related to releasing of medications

Abbreviations Abbreviations
Definition Definition
(written) (written)

PO By mouth CD controlled delivery

PR Per rectum TR time release

TP Topical LA Long acting

SL Sublingual ER extended release

BUCC Buccal XT extra time

IM Intramuscular SR sustained release

IV Intravenous XL extralong, extra large

ID Intradermal DR delayed release

IN Intranasal XR extra release

IP Intraperioneal

4 The Anatomy of a Prescription Label

(A prescription Label)

58
 8
1. Pharmacy information: name, address and phone number.

2. Doctor who wrote the prescription.

3. Prescription information: date the prescription was filled, prescription number.

4. Patient who the prescription for.

5. Medication:

• Directions for taking medication • Refills left

• Quantity in the container • Generic name

• Brand name • Expiration date

• Dose or strength • Safety reminders

5 Directions

Directions = How to use? + How much? + How often? + When? + How long?

How to use?

Administration Verb

Oral Take orally/by mouth

Rectal Put/Insert into the rectum

Skin/Mucous membranes Apply to affected skin/mucous membranes

Insert into the vagina

Vagina
Topical Apply to vaginal mucosa

Spray into the nostrils/throat

Ear - Nose - Throat - Eye
Instill drops into the ear/eye-pocket

Sublingual Under the tongue Place under the tongue

Inside the cheek Place/Stick to the inside of the cheek

(buccal administration)

Inhalation Inhale by mouth

Parenteral Subcutaneous Inject into the fat layer under the skin (Ex. Insulin)

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8
How much?

Administration Quantity

• 1 tablet
Solid forms
Oral • 2 capsules

liquid forms • 10ml

Rectal Suppositories • 1 suppository

Skin/Mucous membranes • a thin layer of medication

• 1 tablet
Vagina
Topical • 1 pessary

• 1 spray
Ear – Nose – Throat – Eye
• 2 drops

• 1 tablet
subligual
• 1 film

Inhalation • 2 puffs

• 10 units
Parenteral Subcutaneous
• 3.4 ml

How often?

Abbreviations Abrreviations
Definition Definition
(written) (written)

- Daily - Every other day

BID Twice a day Q4H Every four hours

TID Three times a day Q4-6H Every four to six hours

QID Four times a day QWK Every week

(Daily and Every other day must be written in full)

When?

Abbreviations Abrreviations
Definition Definition
(written) (written)

AC Before meals - In the morning

PC After meals - In the evening

HS At bedtime - At noon

PRN When necessary - Before breakfast/lunch/dinner

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 8
How long?

• For 7 days
• For 2 weeks
• Until all taken

Example

Administration Example

Solid forms Take one tablet orally daily as needed for symptoms for 7 days.
Oral
Liquid forms Take 5 mL (1 teaspoon) by mouth in the morning and at night for 10 days.

Suppositories Insert one suppository into the rectum every four hours as needed for pain.

Rectal Insert the nozzle into the rectum, slowly squeeze the liquid from the container
Liquid forms until it is empty, then gently remove the nozzle from the rectum.
Use one bottle rectally daily.

Skin/Mucous Apply a thin layer to entire affected areas after washing. Use twice a day in
membranes the morning and in the evening for 2 weeks.

Insert the pessary as deep as possible into the vagina by the applicator or
Vagina finger.
Topical
Use one pessary daily at bedtime until all taken.

Ear - Nose - Spray twice in each nostrils as needed.

Throat - Eye
Instill one drop in the affected eye(s) up to four times daily for 7 days.

Place 1 tablet under the tongue as needed for the pain.

Sublingual
Do not crush, chew or swallow the tablets.

Inhalation Inhale 2 puffs by mouth every 4 hours.

Inject 10 units into the fat layer under the skin at bedtime and add 1 unit daily
Subcutaneous
Parenteral at bedtime until the FBS (fasting blood sugar) is less than 100, if FBS is less
than 70, decrease by 1 unit daily until over 70 and call a medical doctor.

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6 Medication guides

Effects Side effects

Question: What is this medicine used for?
Answer: This medicine is used for/to …
For example:
• What is paracetamol used for?
• Paracetamol is used for treatment of the
pain such as headache, toothache or muscle
pain.
User objects
Question: Who can use this medicine?
Answer: This medicine is used for …
Question: What are possible side effects?
Answer:
• Common ABC side effects may include …
• Stop using medicine and call your doctor if
you have …
For example:
• Common aspirin side effects may include
upset stomach or mild headache.
• Stop using medicine and call your doctor if
you have heartburn and diarrhea.
Storage

Question: How to store this medicine?

For example:
Answer:
• Who can use aspirin?
• Keep this medicine out of the sight and reach
• Aspirin is used for adults and children from the
of children.
age of 10.
• Do not use this medicine after the expiry
Doses date.

Question: What happens if I miss a dose?

Answer:
• Use the missed dose as soon as you
remember.
• Skip the missed dose if it is almost time for
your next scheduled dose.
• Do not use extra medicine to make up the
missed dose.
Question: What happens if I overdose?
Answer: Seek medical attention or call an
emergency.

GLOSSARY

62
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63
9 Urinary System

1 The Anatomy of Urinary System

Adrenal gland Spleen

Liver Renal artery

Twelfth rib Renal vein

Left kidney

Right kidney
Abdominal aorta

Ureter
Inferior vena cava

Urinary bladder
Common iliac artery
and vein

urethra

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 9
2 Introduction to Urinary System

The urinary system removes nitrogenous waste

from the blood so that it does not accumulate
and become harmful. As blood moves through
the kidneys, the kidneys filter nitrogenous
wastes to form urine. Urine is composed of
water, salts, and acids. Urine then leave the the
body through the ureters, urinary bladder, and
urethra.

Each day the kidneys process about 200 quarts

of blood to filter out two quarts of urine. The
kidneys are also responsible for maintaining the
proper balance of water, electrolytes, and acids
in body fluids. Electrolytes such as sodium and
potassium are small molecules that conduct an
The kidneys also secrete hormones such as
electrical charge. These electrolytes are
renin which raises blood pressure and
necessary for proper functioning of muscle and
erythropoietin which stimulates red blood cell
nerve cells. The kidneys adjust the amount of
production in the bone marrow. The kidneys
water and electrolytes by secreting some
also secrete calciferol, an active form of vitamin
substances into the urine and holding back other
D that is necessary for the absorption of
in the bloodstream for the body to use.
calcium from the intestine. Kidneys are further
responsible for degrading and eliminating
hormones such as insulin and the parathyroid
hormone from the bloodstream.

The process of forming and expelling urine

starts with the bloodstream. The blood passes
through the renal arteriole to the glomerulus.
The glomerulus is a tiny ball of capillaries. As
the blood passes through the many glomeruli
the thin walls of the glomerulus permit water,
salts, sugar and urea to leave the bloodstream.

These materials then collect in the glomerular

capsule, a tiny cup like structure that surrounds
each glomerulus. Attached to each glomerular
capsule is a long, twisted tube called a renal
tubule.

As water, sugar, salts, urea, and other wastes pass through the renal tubule, almost all of the sodium
return to the bloodstream through tiny capillaries, this is the active process knows of reabsorption. The
last process in the formation of urine is secretion of some substances such as potassium, acids and drugs
from the bloodstream into the renal tubule.
The urine from the renal tubules lead to the renal pelvis, a basin like area in the central part of the kidney.
The renal pelvis narrow into the ureter which carries the urine to the urinary bladder, a muscular sac, that
temporarily stores urine.
The urine exits the bladder and travels to the urethra then to the urinary meatus and exits the body.

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3 Pathology Vocabulary 5 Urinary System Terms

The following are pathologic conditions Combining Form Meaning

associated with the urinary system:
• Glomerulonephritis: Inflammation of the cali/o, calic/o calys; cup-shaped
glomeruli within the kidney
cyst/o urinary bladder
• Nephrolithiasis: Kidney stones
• Polycystic Kidney Disease (PKD): Multiple
glomerul/o glomerrulus
fluid-filled sac within and on the kidney
• Pyelonephritis: Inflammation of the lining of meat/o meatus
the renal pelvis and renal parenchyma
• Renal Cell Carcinoma: Cancerous tumor of nephr/o kydney
the kidney in adulthood
trigone (region of the
• Bladder Cancer: Malignant tumor of the trigon/o
blaader)
urinary bladder
• Diabetes Mellitus (DM): Insulin is not ureter/o ureter
secreted adequately or tissues are resistant
urethr/o urethra
to its effects

vesic/o urinary bladder

4 Lab tests and Clinical Procedures

Here are some common laboratory tests and

Pharmacology of drugs acting on
clinical procedures associated with the urinary 6
system: Urinary Systems
• Urinalysis: An examination of urine to
Pharmacological agents used to treat urinary
determine the presence of abnormal
tract disorders include antibiotics, diuretics,
elements that may indicate various
antidiuretics, urinary antispasmodics, and
pathologic conditions
potassium supplements, which are commonly
• CT Urography: X-ray images obtained using
taken concurrently with diuretics to counteract
computed tomography (CT) show multiple
potassium depletion.
cross-sectional and other views of the
kidneys
Drugs Used to Treat Urinary Disorders
• Kidneys, Ureters, and Bladder (KUB): X-ray
examination (without contrast) of the
This table lists common drug classifications
kidneys, ureters, and bladder
used to treat urinary disorders and their
• Retrograde Pyelogram (RP): X-ray image of
effects:
the renal pelvis and ureters after injection of
contrast through a urinary catheter into the
ureters from the bladder
• Cystoscopy: Direct visualization of the
urethra and urinary bladder with an
endoscope (cystoscope)
• Dialysis: Process of separating nitrogenous
waste materials from the blood
• Lithotripsy: Urinary tract stones are crushed
• Renal Transplantation: Surgical transfer of a
kidney from a donor to a recipient
• Urinary Catheterization: Passage of a
flexible, tubular instrument through the
urethra into the urinary bladder

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 9
Classification Effects

Treat bacterial infections of the urinary tract by acting on the bacterial membrane or
antibiotics
one of its metabolic processes.

Decrease spasms in the urethra and bladder by relaxing the smooth muscles lining
antispasmodics
their walls, thus allowing normal emptying of the bladder.

diuretics Promote and increase the excretion of urine.

potassium supplements Replace potassium after depletion caused by diuretics.

7 Acute Kidney Failure

Overview

Acute kidney failure occurs when your kidneys suddenly become unable to filter waste products from
your blood. When your kidneys lose their filtering ability, dangerous levels of wastes may accumulate,
and your blood's chemical makeup may get out of balance.

Acute kidney failure — also called acute renal failure or acute kidney injury — develops rapidly, usually in
less than a few days. Acute kidney failure is most common in people who are already hospitalized,
particularly in critically ill people who need intensive care.

Acute kidney failure can be fatal and requires intensive treatment. However, acute kidney failure may be
reversible. If you're otherwise in good health, you may recover normal or nearly normal kidney function.

Symptoms

Signs and symptoms of acute kidney failure may include:

• Decreased urine output, although occasionally urine output remains normal
• Fluid retention, causing swelling in your legs, ankles or feet
• Shortness of breath
• Fatigue
• Confusion
• Nausea
• Weakness
• Irregular heartbeat
• Chest pain or pressure
• Seizures or coma in severe cases
Sometimes acute kidney failure causes no signs or symptoms and is detected through lab tests done for
another reason.

When to see a doctor

See your doctor immediately or seek emergency care if you have signs or symptoms of acute kidney
failure.

67
9
Causes

Acute kidney failure can occur when:

• You have a condition that slows blood flow to your kidneys
• You experience direct damage to your kidneys
• Your kidneys' urine drainage tubes (ureters) become blocked and wastes can't leave your body through
your urine

Impaired blood flow to the kidneys

Diseases and conditions that may slow blood flow to the kidneys and lead to kidney injury include:
o Blood or fluid loss

o Blood pressure medications

o Heart attack
o Heart disease
o Infection
o Liver failure
o Use of aspirin, ibuprofen (Advil, Motrin IB, others), naproxen sodium (Aleve, others) or related drugs
o Severe allergic reaction (anaphylaxis)
o Severe burns
o Severe dehydration

Damage to the kidneys

These diseases, conditions and agents may damage the kidneys and lead to acute kidney failure:
o Blood clots in the veins and arteries in and around the kidneys

o Cholesterol deposits that block blood flow in the kidneys

o Glomerulonephritis (gloe-mer-u-loe-nuh-FRY-tis), inflammation of the tiny filters in the kidneys
(glomeruli)
o Hemolytic uremic syndrome, a condition that results from premature destruction of red blood cells
o Infection
o Lupus, an immune system disorder causing glomerulonephritis
o Medications, such as certain chemotherapy drugs, antibiotics and dyes used during imaging tests
o Scleroderma, a group of rare diseases affecting the skin and connective tissues
o Thrombotic thrombocytopenic purpura, a rare blood disorder
o Toxins, such as alcohol, heavy metals and cocaine
o Muscle tissue breakdown (rhabdomyolysis) that leads to kidney damage caused by toxins from
muscle tissue destruction
o Breakdown of tumor cells (tumor lysis syndrome), which leads to the release of toxins that can cause
kidney injury

Urine blockage in the kidneys

Diseases and conditions that block the passage of urine out of the body (urinary obstructions) and can
lead to acute kidney injury include:
o Bladder cancer
o Blood clots in the urinary tract

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 9
o Cervical cancer
o Colon cancer
o Enlarged prostate
o Kidney stones
o Nerve damage involving the nerves that control the bladder
o Prostate cancer

Risk factors

Acute kidney failure almost always occurs in connection with another medical condition or event.
Conditions that can increase your risk of acute kidney failure include:
• Being hospitalized, especially for a serious condition that requires intensive care
• Advanced age
• Blockages in the blood vessels in your arms or legs (peripheral artery disease)
• Diabetes
• High blood pressure
• Heart failure
• Kidney diseases
• Liver diseases
• Certain cancers and their treatments

Complications

Potential complications of acute kidney failure include:

• Fluid buildup. Acute kidney failure may lead to a buildup of fluid in your lungs, which can cause
shortness of breath.
• Chest pain. If the lining that covers your heart (pericardium) becomes inflamed, you may experience
chest pain.
• Muscle weakness. When your body's fluids and electrolytes — your body's blood chemistry — are out
of balance, muscle weakness can result.
• Permanent kidney damage. Occasionally, acute kidney failure causes permanent loss of kidney
function, or end-stage renal disease. People with end-stage renal disease require either permanent
dialysis — a mechanical filtration process used to remove toxins and wastes from the body — or a
kidney transplant to survive.
• Death. Acute kidney failure can lead to loss of kidney function and, ultimately, death.

Prevention

Acute kidney failure is often difficult to predict or prevent. But you may reduce your risk by taking care
of your kidneys. Try to:
• Pay attention to labels when taking over-the-counter (OTC) pain medications. Follow the instructions
for OTC pain medications, such as aspirin, acetaminophen (Tylenol, others), ibuprofen (Advil, Motrin
IB, others) and naproxen sodium (Aleve, others). Taking too much of these medications may increase
your risk of kidney injury. This is especially true if you have pre-existing kidney disease, diabetes or
high blood pressure.

69
9
• Work with your doctor to manage kidney and other chronic conditions. If you have kidney disease or
another condition that increases your risk of acute kidney failure, such as diabetes or high blood
pressure, stay on track with treatment goals and follow your doctor's recommendations to manage
your condition.
• Make a healthy lifestyle a priority. Be active; eat a sensible, balanced diet; and drink alcohol only in
moderation — if at all.

8 What is Urinary Catheterization?

In urinary catheterization, a catheter (hollow tube) is inserted into the bladder to drain or collect urine.
There are two main types of urinary catheterization: indwelling catheterization and clean intermittent
catheterization (CIC).

Indwelling catheterization
9 How is it done?
In this type of catheterization, one end of the
Introduce yourself
catheter remains inside the bladder. A small,
Adam: Hi. My name is Adam and I’m a final year
inflated balloon at the tip of the catheter inside
medical student.
the bladder keeps the end of the catheter from
slipping out. Urine flows from the bladder
Confirm patient details
through the catheter and collects in a drainage
Adam: Can I check your name?
bag. If the patient is not bedridden, this drainage
Luis: It’s Luis Potter.
bag can be worn on the leg, where it can be
Adam: Great. And what's your date of birth?
hidden under a skirt or slacks. If the patient is
Luis: It’s the fifth of the ninth, 1988
bedridden, the drainage bag usually is attached
to the lower portion of the hospital bed (near the
Explain procedure
floor). This position allows gravity to help the
Adam: Okay. I need to insert a catheter to
urine drain.
monitor your urine output. This will involve me
An indwelling catheter can be used for short-
inserting a small flexible tube into your penis to
term or long-term care.
reach the bladder. It might be a little bit
uncomfortable but it shouldn't be too painful. I'll
CIC insert some local anaesthetic into the penis to
make the procedure as comfortable as possible.
In CIC, the urinary catheter does not remain
Have you ever been allergic to local anaesthetic?
inside the bladder. It is inserted into the bladder
Luis: No.
only long enough to allow the bladder to drain.
Then, it is removed. CIC can be done by the
Ensure a chaperone is present
patient or by the patient's caregiver.
Adam: Okay. There'll be a member of the nursing
For short-term catheterization after surgery, and
staff present throughout who acts as a
in certain paralyzed patients, CIC often is better
chaperone.
than an indwelling catheter. This is because CIC
is less likely to cause a urinary-tract infection in
Gain consent
these situations.
Adam: Does all of that sound okay?
Luis: Yeah. I’m fine.
Adam: Great. I'll just go and get my equipment
ready.

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Urinary catheterization
• Clean the procedure trolley using disinfectant
wipes.
• Wash hands.
• Put on apron.
• Remove outer packaging of catheter pack.
• Open catheter pack aseptically.
• Check catheter expiry date.
• Set up equipment on sterile field: sterile
drape, gallipot, catheter, sterile receiver,
absorbent pad, sterile gloves, water for
catheter balloon, local anaesthetic gel,
catheter bag.
• Pour NaCl 0.9% into gallipot for use during
cleaning.
• Expose patient’s genital area.
• Wash hands.
• Put on sterile gloves.
• Place absorbent pad under patient to prevent
spillages.
• Clean the area surrounding the urethral
opening. The direction of cleaning should be
away from the urethral opening.
• Discard gloves and wash hands.
• Put on new pair of sterile gloves.
• Drape area surrounding penis.
• Inject local anaesthetic into the urethra
(check expiry date or medication type).
Adam: I'm going to insert some local anesthetic
now. It might sting a little bit but it should go
numb quite quickly.
• Allow up to 5 minutes for the
anaesthetic to take effect.
• Place sterile receiver below the penis.
9 Medical equipment
(1)
9
• Open catheter wrapper ensuring not to touch
the catheter tip.
• Insert catheter gently into the urethra.
Adam: Now I'm going to insert a catheter.
Grip the penis to prevent the catheter from
sliding back out.
• Pull back the wrapper to expose more of the
catheter.
• Loosen grip and continue to insert the
catheter.
• Fully insert the catheter (ensure urine is
draining before inflating balloon)
• Inflate balloon with the water filled syringe.
Adam: Let me know if you feel any pain.
• Observe for any signs of discomfort.
• Gently retract catheter until resistance is felt.
• Replace foreskin if appropriate.
• Attach catheter bag.
• Place catheter below the level of the patient.
• Clean up the patient and dispose of
equipment or gloves.
• Re-cover patient to preserve dignity.
• Wash hands.
Thank patient
Adam: Okay that's the end of the procedure.
Thank you very much.
Luis: Thank you
To complete the procedure
Adam: To complete the procedure, I would fill
local out all relevant documentation. Making sure to
note urine color, residual urine volume and any
complications.
(2) (3)
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9

(4) (5)

(6) (7) (8)

(1) Urinary catheter: a tube placed in the body to drain and collect urine from the bladder.

(2) Drainage bag: a bag attached to a catheter which is inserted to patient’s bladder to collect urine.

(3) Absorbent pad: Pads used for personal hygiene usually for absorbing urine or feces.

(4) Commode chair: a type of chair used by someone who needs help going to the toilet due to illness,
injury or disability.

(5) Drape: A paper or cloth covering placed over a patient's body during medical examination or treatment,
designed to provide privacy or a sterile operative field.

(6) Dipstick: a thin, plastic stick with strips of chemicals on it which is placed in the urine to detect
abnormalities.

(7) Cystoscope: an instrument inserted into the urethra for examining the urinary bladder.

(8) Hemodialysis machine: A machine used in dialysis that filters a patient's blood to remove excess water
and waste products when the kidneys are damaged, dysfunctional, or missing.

GLOSSARY

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1 Parts of Female Reproductive System

Ovary
Fallopian Tube

Fimbriae Uterus

Bladder
Fornix

Cervix
Pubic Bone
Rectum
Clitoris
Vagina
Bulb of Vestibule
Anus
Urethra
Bartholin’s Gland
Labia Minora

Labia Majora

• Ovary: Small almond shaped organ located in the pelvis which produce egg cells and hormones.
• Fallopian Tubes: Pair of ducts through which the ovum travels to the uterus.
• Uterus: Hollow pear-shaped muscular organ in which the embryo and fetus develop, and from which
menstruation occurs.
• Vagina: Muscular, mucosa-lined canal extending from the uterus to the exterior of the body.
• Clitoris: Organ of sensitive erectile tissue anterior to the opening of the female urethra.
• Cervix: Lower, neck-like portion of the uterus.
• Labia Minora: Smaller, innermost lips of the vagina.
• Labia Majora: Larger, outermost lips of the vagina.

2 Introduction to Female Reproductive System

Sexual reproduction is the union of the female sex cell, the ovum, and the male sex cell, the sperm. Each
of these cells are known as a gamete and have half the number of chromosomes needed to create a new
organism.

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During fertilization, the nuclei of the two gamete unite to form a single nucleus with half of the
chromosomes and genetic code from each parent. Gonads, special organs in males and females produce
the egg and sperm cells. Ovaries are the female gonads and testes are the male gonads.
Once an ovum leaves the ovary it travels down one of two fallopian tubes leading to the uterus. If sexual
intercourse has occurred and sperm cells travel into the fallopian tube they can penetrate the ovum. This
is called fertilization.
The fertilized ovum is then called a zygote. After numerous cell divisions, a ball of cells forms and the
zygote becomes an embryo and finally a fetus.
The period of gestation or development in the uterus is gestation or pregnancy and lasts 38 or 40
weeks.
The female reproductive system consists of organs that produce ova and provide a place for the growth
of the embryo.
The sex organs also supply important hormones that contribute to the development of female secondary
sex characteristics such as body hair, breast development, structural changes in the bones and fat.
The ova are present from birth in the female ovary but begin to mature and are released from the ovary
in 21 to 28 day cycles.
The occurrence of the first cycle is called menarche.
Menstrual cycles continue until menopause when all of the eggs have been released, hormone
production diminishes, and menstruation ends.
If fertilization occurs during the time period between menarche and menopause, the fertilized egg will
grow and develop in the uterus. A new blood vessel-rich organ called the placenta develops in order to
nourish the embryo.
If fertilization does not occur, hormone changes will result in shedding of the uterine lining and
menstruation occurs.
The hormones of the ovaries are estrogen and progesterone and they both play important roles in the
processes of menstruation and pregnancy as well as in the development of secondary sex characteristics.
The pituitary gland located at the base of the brain, secretes other hormones the govern that
reproductive functions of the ovaries, breasts and uterus.

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3 Female Reproductive System Pathology

Term Definition

Gynecology

Carcinoma of the Cervix Malignant cells within the cervix (cervical cancer).

Cervicitis Inflammation of the cervix.

Carcinoma of the Endometrium Malignant tumor of the uterine lining.

Endometriosis Endometrial tissue located outside the uterus.

Fibroids Benign tumors of the uterus.

Ovarian Carcinoma Malignant tumor of the ovary.

Ovarian Cysts Collection of fluid within sacs (cysts) in the ovary.

Pelvic Inflammatory Disease (PID) Inflammation and infection of organs in the pelvic region.

Carcinoma of the Breast Malignant tumor of the breast.

Pregnancy

Ectopic Pregnancy Implantation of the fertilized egg in any site other than the normal

uterine location.

Placenta Previa Implantation of the placenta over the cervical opening or in the lower

region of the uterus.

Preeclampsia Abnormal condition associated with pregnancy, marked by high blood

pressure, proteinuria, edema, and headache.

Neonatal

Down Syndrome Chromosomal abnormality results in mental retardation, retarded

growth, a flat face with a short nose, low-set ears, and slanted eyes.

Hydrocephalus Accumulation of fluid in the spaces of the brain.

Meconium Aspiration Syndrome Abnormal inhalation of meconium produced by a fetus or newborn.

Pyloric Stenosis Narrowing of the opening of the stomach to the duodenum.

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4 Clinical Tests & Procedures

• Pap Test: Microscopic examination of stained cells removed from the vagina and cervix.
• Pregnancy Test: Blood or urine test to detect the presence of hCG.
• Hysterosalpingography: X-ray imaging of the uterus and fallopian tubes after injection of contrast
material.
• Mammography: X-ray imaging of the breast.
• Pelvic Ultrasonography: Recording images of sound waves as they bounce off organs in the pelvic
region.
• Colposcopy: Visual examination of the vagina and cervix using a colposcope.
• Conization: Removal of a cone-shaped section (cone biopsy) of the cervix.
• Cryosurgery: Use of cold temperatures to destroy tissue.
• Dilation & Curettage (D&C): Widening the cervix and scraping off the endometrial lining of the uterus.
• Laparoscopy: Visual examination of the abdominal cavity using an endoscope.
• Tubal Ligation: Blocking the fallopian tubes to prevent fertilization from occurring.
• Abortion: Termination of pregnancy before the embryo or fetus can exist on its own.
• Amniocentesis: Needle puncture of the amniotic sac to withdraw amniotic fluid for analysis.
• Cesarean Section: Surgical incision of the abdominal wall and uterus to deliver a fetus.
• Fetal Monitoring: Continuous recording of the fetal heart rate and maternal uterine contractions to
assess fetal status and the progress of labor.
• In Vitro Fertilization (IVF): Egg and sperm cells are combined outside the body in a laboratory dish to
facilitate fertilization.

5 Female Reproductive System Terms

Female Reproductive System Combining Form

Combining Form Meaning Combining Form Meaning

amni/o amnion my/o muscle

carvic/o cervix, neck nat/i birth

chori/o, chorion/o chorion obstetr/o pregnancy and childbirth

colp/o vagina o/o egg

culp/o cul-de-sac oophor/o ovary

episi/o vulva ov/o egg

galact/o milk ovari/o ovary

gynec/o woman, female ovul/o egg

hyster/o uterus, womb perine/o perineum

lac/o milk phor/o to bear

mamm/o breast salping/o fallopian tube

mast/o breast uter/o uterus

men/o menses, menstruation vagin/o vagina

metr/o, metri/o uterus vulv/o vulva

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Female Reproductive System Suffixes & Prefixes

Suffix Meaning Prefix Meaning

-arche beginning dys- painful

-cyesis pregnancy endo- within

-gravida pregnant in- in

-parous bearing, bringing forth intra- within

-rrhea disscharge multi- many

-salpinx fallopian tube mulli- no, not, none

-tocia labor, birth pre- before

-version act of turning primi- first

-- -- retro- backward

6 An overview of the pelvic examination

Overview

During a pelvic exam, a nurse evaluates your reproductive organs. You might have a pelvic exam as part of
your regular checkup. Or your doctor might recommend a pelvic exam if you have symptoms such as
unusual vaginal discharge or pelvic pain.
A pelvic exam usually lasts only a few minutes. The nurse checks your vulva, vagina, cervix, ovaries, uterus,
rectum and pelvis for any abnormalities. A pap test, which screens for cervical cancer, is often performed
during a pelvic exam.

A pelvic exam generally includes:

External visual exam: First, the nurse looks at your vulva, checking for irritation, redness, sores, swelling or
other abnormalities.
Internal visual exam: Next, the nurse uses a speculum - a plastic or metal-hinged instrument shaped like a
duck's bill - to spread open your vaginal walls and see your vagina and cervix. The speculum might be
warmed before it's inserted to make it more comfortable for you. Inserting and opening the speculum
causes pressure that can be uncomfortable for some women. Relax as much as possible to ease
discomfort, but tell the nurse if you're in pain.
Pap test: If your pelvic exam includes a pap test (pap smear), the nurse will swipe a small wand to collect a
sample of your cervical cells before removing the speculum.
Physical exam: Because your pelvic organs, including your uterus and ovaries, can't be seen from outside
your body, the nurse needs to feel (palpate) your abdomen and pelvis for this part of the exam. The nurse
will insert two lubricated, gloved fingers into your vagina with one hand, while the other hand presses
gently on the outside of your lower abdomen. During this part of the exam, the nurse will check the size
and shape of your uterus and ovaries, noting any tender areas or unusual growths. After the vaginal exam,
the nurse will insert a gloved finger into your rectum to check for tenderness, growths or other
irregularities.

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7 How is it done?
Introduce yourself
Polly: Hello, my name is Polly. I'm one of the
medical students.
Confirm patient details
Polly: Can I just confirm your name and date of
birth?
Mrs. Smith: My name is Grace Smith, and I was
born on the 26th of January 1987.
Explain examination
Polly: I've been asked today to perform an
internal vaginal examination. This involves
putting two fingers inside the vagina and a
hand onto the abdomen. It will enable me to
assess the vagina the uterus and the ovaries. It
shouldn't be painful, but it may be slightly
uncomfortable. And if at any point you want me
to stop, you just have to say and I will.
Ensure a chaperone is present
Polly: There will be a female member of staff
chaperoning us throughout the examination. Do
you have any questions?
Mrs. Smith: No, that's fine.
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Gain consent
Polly: Which case are you happy for us to
continue with the examination?
Mrs. Smith: Yeah, that's fine.
Enquire about possible pregnancy
Polly: Before we begin, can I ask you? Is there
any possibility that you could be pregnant?
Mrs. Smith: No.
Polly: Would you like to empty your bladder
before the examination?
Mrs. Smith: No.
Polly: If you can step behind the curtain, remove
your lower half of clothing including your
underwear and sit on the couch. You can cover
yourself over with the blanket provided.
Internal vaginal examination
• Wash hands.
• Gather equipment: lubricating jelly, paper
towels, gloves.
Polly: Mrs. Smith, are you comfortable? Are you
happy for me to start the examination now?
Mrs. Smith: Yeah
• Position patient supine
10
Polly: First of all, I'd like to change your position
so that you're lying down.
• Put on gloves
• Position patient: modified lithotomy position.
Polly: Now I'd like you to do is bend your knees
up, bring your heels together and relax your
knees outwards as much as possible. I'm going
to uncover you now. But just to remind you if
you want me to stop at any point during the
examination, just let me know.
• Inspect the vulva: scars, erythema, masses,
discharge or bleeding, rash or vesicles.
• Assess for vaginal prolapse.
Polly: Okay Mrs. Smith, can you just cough for
me?
• Lubricate fingers.
Polly: I'm now going to insert two fingers into
the vagina.
• Separate labia and insert fingers.
• Assess vagina and cervix (cervical excitation).
• Palpate the uterus.
• Palpate the adnexa.
• Withdraw and inspect fingers (blood or
discharge)
• Re-cover.
Polly: That completes the examination. Here's
some paper towels. I'll leave you to get dressed
and then you can come and sit down with me
when you're finished.
• Wash hands.
Summarise findings
Polly: Today I performed a vaginal examination
of Mrs. Smith, the 29 year old female. On
examination, the abdomen was soft and non-
tender. The vulva was normal. Internally the
vagina was normal. There was no cervical
excitation. The uterus was of normal shape, size
and non-tender and was retroverted. The
adnexa were unremarkable with no masses. In
summary, this was a normal vaginal
examination.
To complete the examination
Polly: To complete my examination. I would
perform urinalysis, a urine pregnancy test. I
would also like to perform a speculum
examination. And if appropriate swabs, I could
also request an abdominal or transvaginal pelvic
ultrasound.

8 Medical equipment

(1) (2) (3) (4)

(5) (6) (7) (8)

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(1) Speculum: a plastic or metal instrument, shaped like a duck’s bill, that is put into a long narrow part of
the body in order to open it up, so it can be examined.

(2) Gynecological exam chair: a chair designed for gynaecological examination which has stirrups for
patients placing their feet.

(3) Sanitary napkin: a disposable absorbent pad used to absorb blood during menstruation.

(4) Tampon: a plug of soft material inserted into the vagina to absorb menstrual blood.

(5) Menstrual cup: A reusable cup-shaped device that is inserted into the vagina to collect menstrual
blood.

(6) Intrauterine device (IUD): a small, often T-shaped birth control device that is inserted into the uterus
to prevent pregnancy.

(7) Condom: a thin, rubber covering that a man can wear on this penis during sex to prevent pregnancy or
protect against disease.

(8) Lubricant: a liquid or gel that women and their partners can apply during sex to make the vulva,
vagina, or anal area wetter.

GLOSSARY

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82
 Reference

1 Barbara A.Gylys Mary Ellen Wedding, Medical Terminology System, A body System
Approach, 8th , 2017
2 Ann Ehrlich, Carol L.Schroeder, Medical Terminology for Health Professions, 7th , 2013

3 Medical English Course, DoaneX University, EdX

4 Clinical Terminology for the international and US students, University of Pittsburbh, Coursera

5 https://en.wikipedia.org/wiki/Oxygen_saturation_(medicine)

6 https://formulation.pharmaceuticalconferences.com

7 https://www.coursera.org/learn/clinical-terminology

8 https://www.healthline.com/health/copd

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20369048

15 https://www.mayoclinic.org/tests-procedures/pelvic-exam/about/pac-20385135

16 https://www.nhs.uk/conditions/electrocardiogram/

17 https://www.youtube.com/watch?v=Z-O_JYtyQqE&t=209s

18 https://www.youtube.com/watch?v=kacMYexDgHg&t=2s

19 https://www.youtube.com/watch?v=2OaTtVgg16o

20 https://www.youtube.com/watch?v=vE99rZ7JT3Q

21 https://www.youtube.com/watch?v=cctNcVuGYfo

22 https://www.youtube.com/watch?v=vE99rZ7JT3Q

23 https://www.webmd.com/a-to-zguides/understanding-anemia-symptoms#1

24 https://www.webmd.com/heart-disease/electrocardiogram-ekgs