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(eBook PDF) DHO Health Science
Updated 8th Edition

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vi C O n te n ts
CHAPTER 14 Promotion of Safety 361

Chapter Objectives 361 Today’s Research: Tomorrow’s Health Care 383
Key Terms 361 Summary 384
14:1 Using Body Mechanics 362 Internet Searches 384
14:2 Preventing Accidents and Injuries 364 Review Questions 385
14:3 Observing Fire Safety 379
CHAPTER 15 Infection Control 386

Chapter Objectives 386 15:7 Cleaning with an Ultrasonic Unit 416
Key Terms 386 15:8 Using Sterile Techniques 419
15:1 Understanding the Principles 15:9 Maintaining Transmission-Based
of Infection Control 387 Precautions 431
15:2 Bioterrorism 393 Today’s Research: Tomorrow’s Health Care 444
15:3 Washing Hands 396 Summary 444
15:4 Observing Standard Precautions 399 Internet Searches 445
15:5 Sterilizing with an Autoclave 408 Review Questions 445
15:6 Using Chemicals for Disinfection 414
CHAPTER 16 Vital Signs 446

Chapter Objectives 446 16:6 Measuring and Recording Apical Pulse 468
Key Terms 446 16:7 Measuring and Recording Blood Pressure 471
16:1 Measuring and Recording Vital Signs 447 Today’s Research: Tomorrow’s Health Care 476
16:2 Measuring and Recording Temperature 449 Summary 476
16:3 Measuring and Recording Pulse 462 Internet Searches 477
16:4 Measuring and Recording Respirations 464 Review Questions 477
16:5 Graphing TPR 466
CHAPTER 17 First Aid 478

Chapter Objectives 478 17:8 Providing First Aid for Cold Exposure 517
Key Terms 478 17:9 Providing First Aid for Bone and Joint Injuries 519
17:1 Providing First Aid 479 17:10 Providing First Aid for Specific Injuries 525
17:2 Performing Cardiopulmonary Resuscitation 481 17:11 Providing First Aid for Sudden Illness 531
17:3 Providing First Aid for Bleeding and Wounds 499 17:12 Applying Dressings and Bandages 536
17:4 Providing First Aid for Shock 504 Today’s Research: Tomorrow’s Health Care 542
17:5 Providing First Aid for Poisoning 507 Summary 542
17:6 Providing First Aid for Burns 511 Internet Searches 542
17:7 Providing First Aid for Heat Exposure 515 Review Questions 543
CHAPTER 18 Preparing for the World of Work 544

Chapter Objectives 544 18:5 Determining Net Income 558
Key Terms 544 18:6 Calculating a Budget 560
18:1 Developing Job-Keeping Skills 545 Today’s Research: Tomorrow’s Health Care 562
18:2 Writing a Cover Letter and Preparing Summary 562
a Résumé 547 Internet Searches 563
18:3 Completing Job Application Forms 553 Review Questions 563
18:4 Participating in a Job Interview 555
Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s).
Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.
C O n te n ts vii
Part 2 Special Health Care Skills 564

CHAPTER 19 Dental Assistant Skills 566
Chapter Objectives 566 19:8 Positioning a Patient in the Dental Chair 602
Key Terms 567 19:9 Demonstrating Brushing and
Career Highlights 568 Flossing Techniques 604
19:1 Identifying the Structures and Tissues 19:10 Taking Impressions and Pouring Models 608
of a Tooth 568 19:11 Making Custom Trays 621
19:2 Identifying the Teeth 571 19:12 Maintaining and Loading an Anesthetic
19:3 Identifying Teeth Using the Universal/ Aspirating Syringe 624
National Numbering System and the 19:13 Mixing Dental Cements and Bases 631
Federation Dentaire International 19.14 Preparing Restorative Materials—Amalgam
(FDI) System 574 and Composite 637
19:4 Identifying the Surfaces of the Teeth 577 19:15 Developing and Mounting Dental
19:5 Charting Conditions of the Teeth 580 Radiographs (X-Rays) 643
19:6 Operating and Maintaining Dental Today’s Research: Tomorrow’s Health Care 649
Equipment 586 Summary 649
19:7 Identifying Dental Instruments Internet Searches 650
and Preparing Dental Trays 595 Review Questions 650
CHAPTER 20 Laboratory Assistant Skills 651

Chapter Objectives 651 20:8 Performing an Erythrocyte
Key Terms 651 Sedimentation Rate 688
Career Highlights 652 20:9 Measuring Blood-Sugar (Glucose) Level 691
20:1 Operating the Microscope 653 20:10 Testing Urine 695
20:2 Obtaining and Handling Cultures 658 20:11 Using Reagent Strips to Test Urine 696
20:3 Puncturing the Skin to Obtain 20:12 Measuring Specific Gravity 700
Capillary Blood 669 20:13 Preparing Urine for Microscopic
20:4 Performing a Microhematocrit 672 Examination 704
20:5 Measuring Hemoglobin 677 Today’s Research: Tomorrow’s Health Care 707
20:6 Preparing and Staining a Blood Film Summary 708
or Smear 681 Internet Searches 708
20:7 Testing for Blood Types 684 Review Questions 709
CHAPTER 21 Medical Assistant Skills 710

Chapter Objectives 710 21:6 Recording and Mounting an
Key Terms 710 Electrocardiogram 747
Career Highlights 711 21:7 Using the Physicians’ Desk Reference (PDR) 756
21:1 Measuring/Recording Height and Weight 712 21:8 Working with Medications 758
21:2 Positioning a Patient 720 Today’s Research: Tomorrow’s Health Care 761
21:3 Screening for Vision Problems 726 Summary 761
21:4 Assisting with Physical Examinations 729 Internet Searches 762
21:5 Assisting with Minor Surgery and Review Questions 762
Suture Removal 739
viii C O n te n ts
CHAPTER 22 Nurse Assistant Skills 763

Chapter Objectives 763 22:9 Providing Ostomy Care 844
Key Terms 764 22:10 Collecting Stool/Urine Specimens 848
Career Highlights 764 22:11 Enemas and Rectal Treatments 858
22:1 Admitting, Transferring, and Discharging 22:12 Applying Restraints 868
Patients 765 22:13 Administering Preoperative and
22:2 Positioning, Turning, Moving, and Postoperative Care 874
Transferring Patients 772 22:14 Applying Binders 884
22:3 Bedmaking 792 22:15 Administering Oxygen 886
22:4 Administering Personal Hygiene 802 22:16 Giving Postmortem Care 891
22:5 Measuring and Recording Intake and Output 824 Today’s Research: Tomorrow’s Health Care 894
22:6 Feeding a Patient 829 Summary 894
22:7 Assisting with a Bedpan/Urinal 832 Internet Searches 895
22:8 Providing Catheter and Review Questions 895
Urinary-Drainage Unit Care 837
CHAPTER 23 Physical Therapy Skills 896

Chapter Objectives 896 23:3 Administering Heat/Cold Applications 919
Key Terms 896 Today’s Research: Tomorrow’s Health Care 929
Career Highlights 897 Summary 930
23:1 Performing Range-of-Motion (ROM) Internet Searches 930
Exercises 897 Review Questions 930
23:2 Ambulating Patients Who Use Transfer
(Gait) Belts, Crutches, Canes, or Walkers 906
CHAPTER 24 Business and Accounting Skills 931

Chapter Objectives 931 24:5 Composing Business Letters 954
Key Terms 931 24:6 Completing Insurance Forms 959
24:1A Filing Records 932 24:7 Maintaining a Bookkeeping System 965
24:1B Filing Records Using the Alphabetical or 24:8 Writing Checks, Deposit Slips, and Receipts 970
Numerical System 934 Today’s Research: Tomorrow’s Health Care 976
24:2 Using the Telephone 938 Summary 976
24:3 Scheduling Appointments 943 Internet Searches 977
24:4 Completing Medical Records and Forms 947 Review Questions 977
Appendix A: Career and Technical Student Glossary984

Organizations (CTSOs) 978 References1007
Appendix B: Correlation to National Health Index1013
Care Foundation Standards 981
Appendix C: Metric Conversion Charts 982
Preface
Health Science, updated eighth edition, was written to the underlying principles, however, the student can
provide the beginning student in health science educa- adapt the procedure as necessary and still observe cor-
tion (HSE) with the basic entry-level knowledge and skills rect technique.
required for a variety of health care careers. Although Information Sections (Textbook): The initial num-
each specific health care career requires specialized bered sections for each topic in this text are information
knowledge and skills, some knowledge and skills are sections which provide the basic knowledge the student
applicable to many different health careers. In short, this must acquire. These sections explain why the knowl-
book was developed to provide some of the core knowledge is important, the basic facts regarding the particu-
edge and skills that can be used in many different fields. lar topic, and how this information is applied in various
Health care is in a state of constant change. This health care careers. Most information sections refer the
change is reflected in the title of this textbook. Previ- student to the assignment sheets found in the student
ously called Diversified Health Occupations, the title has workbook.
been changed to reflect the fact that health care careers Assignment Sheets (Workbook): After students have
are based on science, or the knowledge and skills related read the information in the initial section of a topic, they
to the natural or physical world. The scientific founda- are instructed to go to the corresponding assignment
tion presented in this textbook is required in over 200 sheet. The assignment sheets allow them to test their
different health care careers. comprehension and to return to the information section
to check their answers. This enables them to reinforce
their understanding of the information presented prior
Organization of Text to moving on to another information section.

Procedure Sections (Textbook): The procedure sec-
Health Science, updated eighth edition, is divided into tions provide step-by-step instructions on how to per-
two main parts. Part 1 provides the student with the form specific procedures. The student follows the steps
basic knowledge and skills required for many different while practicing the procedures. Each procedure begins
health care careers. Part 2 introduces the student to basic with a list of the necessary equipment and supplies. The
entry-level skills required for some specific health care terms Note, Caution, and Checkpoint may appear within
careers. Each part is subdivided into chapters. the procedure. Note urges careful reading of the com-
ments that follow. These comments usually stress points
of knowledge or explain why certain techniques are
Chapter Organization used. Caution indicates that a safety factor is involved
Each chapter has a list of objectives and a list of key and that students should proceed carefully while doing
terms (with pronunciations for more difficult words). the step in order to avoid injuring themselves or a
For each skill included in the text, both the knowledge patient. Checkpoint alerts students to ask the instruc-
necessary for the skill and the procedure to perform tor to check their work at that point in the procedure.
the skill are provided. By understanding the principles Checkpoints are usually located at a critical stage. Each
and the procedure, the student will develop a deeper procedure section refers the student to a specific evalua-
understanding of why certain things are done and will tion sheet in the workbook.
be able to perform more competently. Procedures may Evaluation Sheets (Workbook): Each evaluation sheet
vary slightly depending on the type of agency and on the contains a list of criteria on which the student’s perfor-
kind of equipment and supplies used. By understanding mance will be tested after they have mastered a particular
ix
x P reface
procedure. When a student feels he or she has mastered a issues such as career, legal, and technology informa-
particular procedure, he or she signs the evaluation sheet tion. The icons and their meaning are as follows:
and gives it to the instructor. The instructor can grade
the students’ performance by using the listed criteria and Observe Standard Precautions
checking each step against actual performance. Precaution
Because regulations vary from state to state Instructor’s Check—Call Instructor at This Point
regarding which procedures can be performed by
Check
a student in health science education, it is impor- Safety—Proceed with Caution

Legal Safety
tant to check the specific regulations for your

state. A health care worker should never perform any pro- OBRA Requirement—Based on Federal Law
OBRA
cedure without checking legal responsibilities. In addition, for Nurse Assistants

a student should not perform a procedure unless the stu-
Math Skill
dent has been properly taught the procedure and has been Math
authorized to perform it. Legal Responsibility

Legal
Science Skill
Special Features Science
• The text material covers the National Health Care Career

Career Information
Foundation Standards, helping instructors implement
the curriculum elements of this important document. Comm
Communications Skill
An appendix provides a table showing the correlation Technology
of chapters in the book to the National Health Care Technology
Foundation Standards. Health Insurance Portability

HIPAA
• Mandates of the Health Insurance Portability and and Accountability Act

Accountability Act (HIPAA) have been incorporated
Electronic Health Records
throughout the textbook to emphasize the student’s EHR
responsibilities in regard to this act.

• Chapter objectives, included in every chapter, help Enhanced Content New
focus the student on content discussed in the chapter. to the Updated Eighth Edition
• Internet search topics are at the end of each chapter • Vital, updated information on standard precautions,
to encourage the student to explore the Internet to OBRA requirements, and transmission-based pre-
obtain current information on the many aspects of cautions have been included.
health care.
• Information on the Patient Protection and Affordable
• Review questions are at the end of each chapter to Care Act has been added.
enable the student to test his or her knowledge of
• The information on viruses has been expanded
information provided in the chapter.
to include new viruses that can become potential
• Career information has been updated and is stressed sources of epidemics and pandemics. New emphasis
throughout the textbook to provide current informa- is placed on infection control methods to prevent epi-
tion on a wide variety of health care careers. Careers demics and/or pandemics.
have been organized according to the National Health
• A new section on biotechnologies discusses many of
Science Career Clusters. Several new careers have
the sciences emerging in this field.
been added.
• The section on cardiopulmonary resuscitation has been
• Additional emphasis has been placed on cultural
revised to meet the American Heart Association’s new
diversity, technological advances, legal responsibili-
2015 standards for CPR for health care professionals.
ties, new federal legislation pertaining to health care
providers, infection control standards, and safety. • New nutritional guidelines from the U.S. Department
of Agriculture have been incorporated into the nutri-
• Various icons have been included throughout the text-
tion chapter. Instructions are provided for using My
book. These icons denote the integration of academics,
Plate to plan a healthy diet.
such as math, science, and communication; occupa-
tional safety issues, such as standard precautions; fed- • The chapter on computers and technology has been
eral requirements such as HIPAA, electronic health revised to reflect all of the technological changes
records (EHRs), and OBRA; and workplace readiness occurring in health sciences.
P reface xi
Extensive Teaching performance-based assignment and evaluation sheets.

The assignment sheets help students review what they
and Learning Package have learned. The evaluation sheets provide criteria or
standards for judging student performance for each
Health Science, updated eighth edition, has a complete procedure in the text.
and specially designed supplement package to enhance
student learning and workplace preparation. It is also
designed to assist instructors in planning and imple- Instructor Companion Website
menting their instructional programs for the most effi- to Accompany Health Science,
cient use of time and resources. The package contains
the following instructor and student support materials. Updated Eighth Edition
A digital package for teachers provides a wealth of tools
to support and manage the course. To access go to login.
Health Science Teacher’s cengage.com. Register for a Faculty Account and search
Resource Kit using the 13-digit ISBN for the core textbook to locate
ISBN-13: 978-1-3055-0968-9 and access these resources.
A complete guide to implementing a Health Science Components include:
course. The kit explains how to apply content to applied • Customizable Computerized Test Bank powered by
academics and the National Health Care Foundation Cognero® platform providing over 1,800 questions
Standards. This kit is provided as a three-ring binder with and answers directly tied to the textbook in multiple
convenient tabs to easily locate the resources needed for choice, true/false, matching, and short answer format.
specific classroom support. It is also provided online via New to this edition, each question in the computer-
the instructor companion website that accompanies this ized test bank now includes correlation mapping
textbook. It provides: information to the National Healthcare Foundation
• Classroom Management Activities and Skills Standards.
• Lesson Plans • Teacher support slides created in PowerPoint® with
over 900 slides supporting the text for use in class-
• Ready-to-Use Tests and Quizzes
room lectures.
• Classroom Activities
• Electronic Instructor’s Manual in PDF format pro-
• Internet Activities viding electronic access to the printed Health Science
• Leadership Development Activities Instructor’s Manual.
• Applied Academics • Multimedia animations narrating difficult-to-visualize
• Clinical Rotations anatomical and physiological processes, including “The
Anatomy of a Cell,” “The Process of Hearing,” “Blood
• Resources Flow Through the Heart,” and much more.
• Visual aids to reinforce learning in a visual format • Electronic Teacher’s Resource Kit in PDF format pro-
viding electronic access to the printed Health Science
Health Science, Updated Eighth Teacher’s Resource Kit.
Edition, Instructor’s Manual • A comprehensive guide maps the textbook content
to the National Consortium for Health Science Educa-
ISBN-13: 978-1-3055-0967-2
tion’s National Healthcare Foundation Standards and
Provides easy-to-find answers to questions found in the
Accountability Criteria.
Student Workbook. New to this edition, the Instructor’s
Manual now includes answers to the end-of-chapter
review questions found in the textbook. MindTap to accompany Health
Health Science, Updated Eighth Science, Eighth Edition
ISBN-13: 978-1-3055-0954-2
Edition, Student Workbook The DHO MindTap engages diverse types of learners by
ISBN-13: 978-1-3055-0965-8 elevating learning through interactivity and simulations,
This workbook, updated to reflect the Health Science and allows navigation to program-specific content for an
updated eighth edition text, contains perforated, introductory survey course.
xii P reface
• The learning path allows flexibility to meet diverse videos for each primary career and provide basic infor-
classroom needs and learning styles. mation such as duties and responsibilities, career attri-
• Chapter level simulations help students apply knowl- butes, and educational and certification requirements.
edge and elevate their level of learning.
Health Care Career Exploration Interactive
• MindTap allows instructors to adapt the Table of
Classroom DVD
Contents to their course, while a customizable Learn-
ing Path allows instructors to select desired chapter ISBN-13: 978-1-13376-560-8
sections and activities. The Health Care Career Exploration Interactive C
lassroom
DVD contains similar content as the Learning Lab but is
DHO MindTap provides a unique learning path designed to help teachers facilitate in-class discussions
that combines trusted content with an elevated learning and group work using a whiteboard or other computer
experience that cannot be found elsewhere. technology.
Additional Student Resources Activity Manual to Accompany Health Care Career

Exploration Interactive Classroom DVD
Audio podcasts of medical terminology and animations
are available for download at www.cengagebrain.com. Written by Lara Skaggs, M.A.
Search by author last name, book title, or 13-digit ISBN ISBN-13: 978-1-28516-788-6
to access these bonus resources available with the text- Available to support the DVD, this activity manual offers
book. Look for the Free Materials tab. additional classroom tools to support each video seg-
ment, including:
• In-class worksheets help students follow along by
Video Resources Also Available answering questions based on the video content. The
HEALTH CARE CAREER EXPLORATION worksheets can be submitted to the instructor for
Learning Lab for Health Care Career Exploration grading or review.
Instant Access Code, Institutional Purchase, for Your • Assignment sheets can be used as homework assign-
Learning Management System, for 1 year: ISBN-13: 978- ments and require students to use their knowledge of
1-13360-910-0 health care and other resources, such as their textbook
and/or Internet resources, to answer the questions.
Instant Access Code for Your Learning Management
System, for 1 year: ISBN-13: 978-1-13360-919-3 • Capstone activities for each video segment provide
Printed Access Card for 1 Year: ISBN-13: 978-1-13360-856-1 more in-depth application-based activities such as
essay writing, class presentations, and research projects.
Instant Access Code Student Purchase for 1 Year: ISBN-
13: 978-1-13360-926-1 • A related careers worksheet provides additional careers
Instant Access Code Institutional Purchase for 1 Year: that relate to each video segment. The worksheets
ISBN-13: 978-1-13360-927-8 prompt students to identify and research a related
career they are interested in learning more about.
The Learning Lab for Health Care Career Exploration is
an online homework solution. The module-based, inter- Instructor Support Materials
active learning environment provides teachers with a
Additional instructor support materials offer teaching
way to introduce health science students to the variety
tips and strategies for incorporating this material into
of health care career paths available to them. Using video
the curriculum. Log onto login.cengage.com to access
simulations that follow a young, seriously injured patient
these resources.
from an accident scene through all aspects of required
health care to home care, the student is exposed to 31 pri-
mary careers and various additional related careers. From CRITICAL THINKING FOR HEALTH CARE
the patient’s point of view, the student watches video seg- PROFESSIONALS
ments of each primary professional that offer a glimpse
of the health care professional’s role in the care of the Critical Thinking for Health Care Professionals
young patient. Students are introduced to career paths Interactive Classroom DVD
that require various levels of education and training and ISBN-13: 978-1-13328-333-1
offer a variety of salary ranges—careers that range from Fifteen video-based interactive modules direct students
phlebotomist to occupational therapist to psychiatrist. to make decisions related to real-world dilemmas they
Accompanying career profile screens offer interview may encounter on the job and to explore the positive and
P reface xiii
negative outcomes of their selections. Beginning, inter- • Module Discussion: Students answer two discussion
mediate, and advanced scenarios address safety, infec- questions about the module topic.
tion control, HIPAA, communication, ethics, and other • What if?: Students create an alternate scenario using
topics common to all health care disciplines. Designed different information.
for instructor-led in-class discussions and group work
using a whiteboard or other computer technology, this • Post-assessment questions
DVD allows the instructor to spark in-class discussions In addition, each module contains background resource
that prompt students to think critically about real world material to augment students’ knowledge of the topics.
and potentially life-threatening health care issues in a
safe learning environment.
Available Instructor Support Materials
Activity Manual to Accompany Critical Thinking Instructor support materials include the following
for Health Care Professionals Interactive resources for each module:
Classroom DVD
• Answer keys for the pre- and post-assessment ques-
Written by Grant Iannelli, DC tions
ISBN-13: 978-1-28516-785-5
Available to support the DVD, the accompanying activity • A synopsis of each video module
manual includes the following materials for each module: • Instructional goals and teaching strategies
• Pre-assessment questions • Answer keys for all action questions and/or flow charts
to illustrate the various learning paths a student may
• Learning objectives
take based on decisions made at each action point.
• Decision Point Actions: Students identify which
• Impact summaries that illustrate the potential result
action they chose and discuss why they made that
of a decision made by the student when navigating
choice. Each decision point has its own worksheet, so
through the video modules.
there may be 1 to 3 of these worksheets, depending on
the level of the module. Log onto login.cengage.com to access these resources.
About the Authors
Louise Simmers received a Bachelor of Science degree care unit. She has obtained certification from the Emer-
in nursing from the University of Maryland and an MEd gency Nurses Association for the Trauma Nursing Core
from Kent State University. She has worked as a public Course (TNCC) and from the American Heart Asso-
health nurse, medical-surgical nurse, charge nurse in a ciation for Advanced Cardiac Life Support (ACLS). In
coronary intensive care unit, instructor of practical nurs- her current position as charge nurse in her ICU, she
ing, and health science education teacher and school-to- coordinates patient care and staff assignments; man-
work coordinator at the Madison Comprehensive High ages interpersonal conflicts among staff and/or patients
School in Mansfield, Ohio. She is a member of the Uni- and family members; is responsible for ensuring quality
versity of Maryland Nursing Alumni Association, Sigma care to meet the diverse needs of patients and/or fam-
Theta Tau, Phi Kappa Phi, National Education Asso- ily; actively participates in in-services to evaluate new
ciation, and Association for Career and Technical Edu- equipment, medications, hospital services, and supplies;
cation (ACTE), and is a volunteer worker for the Red and teaches and mentors newly employed nurses.
Cross. Mrs. Simmers received the Vocational Educator Sharon Simmers-Kobelak graduated from Miami
of the Year Award for Health Occupations in the State of University, Ohio, with a Bachelor of Business Admin-
Ohio and the Diversified Health Occupations Instructor istration degree. She is currently employed in the edu-
of the Year Award for the State of Ohio. Mrs. Simmers cational publishing industry as an Integrated Solutions
is retired and lives with her husband in Venice, Florida. Specialist. In this position, she assists instructors at pri-
The author is pleased that her twin daughters are now vate career schools to find appropriate print and digital
assisting with the revisions of this textbook. materials for classroom instruction. Sharon also pro-
Karen Simmers-Nartker graduated from Kent vides in-service training for instructors on how to utilize
State University, Ohio, with a Bachelor of Science degree digital assets and the instructor and student resources in
in nursing. She has been employed as a telemetry step- the most productive manner. She achieved President's
down, medical intensive care, surgical intensive care, Club status for 2 years, number one representative sta-
and neurological intensive care nurse. She is currently tus 1 year, and has repeatedly achieved quota in her 20
employed as a charge nurse in an open-heart intensive years in the educational publishing market.
xiv
How to Use This
Textbook
which refers you to an evaluation sheet in the workbook. Following are
brief explanations of these main components:
1. Information Sections (Textbook): Each topic in the text begins with an infor-
mation section to provide the basic knowledge you must acquire. These sec-
tions explain why the knowledge is important, the basic facts regarding the
particular topic, and how this information is applied in various health care
careers. Most information sections refer you to specific assignment sheets
in the workbook. Some information sections provide the basic knowledge
you need to perform a given procedure. These sections explain why things
are done, give necessary facts, stress key points that should be observed,
and, again, refer you to specific assignment sheets in the workbook.
2. Assignment Sheets (Workbook): The assignment sheets provide a review
of the main facts and information presented in the textbook. After you
have read the information in the text, try to answer the questions on the
Chapter Objectives assignment sheet. Refer back to the text to see if your answers are correct.
16
Let your instructor grade your completed assignment sheets. Note any
changes or corrections. Be sure you understand the information before
moving to another topic or performing the corresponding procedure.
Review these goals before you begin reading a chapter to help you
3. Procedure Sections (Textbook): The Procedure sections provide step-by-
focus your study. Then, when you have completed the chapter, step instructions on how to perform the procedures. Follow the steps
Vital Signs
go back and review these goals to see if you have grasped thewhile
keyyou practice the procedures. Each procedure begins with a list
of the necessary equipment and supplies. On occasion, you will see
points of the chapter. any or all of the following threeObjeCTives
ChapTer words in the procedure sections: NOTE,
CAUTION, and CHECKPOINT. NOTEthis
After completing meanschapter,toyoucarefully
should be read
able to:the comments
following, which usually stress
• List the points
five main of knowledge or explain why cer-
vital signs.
tain techniques are used. Fahrenheit means
CAUTION
• Convert to Celsius, orthat
vice a safety factor is involved
versa.
and that you should •proceed carefully
Read a clinical thermometer while doing
to the nearest the step
two-tenths in order to
of a degree.
• Measure and record oral temperature accurately.
avoid injuring yourself or the patient. CHECKPOINT means to ask your
• Measure and record rectal temperature accurately.
16
instructor to check you at that point in the procedure. Checkpoints are
• Measure and record axillary temperature accurately.
usually located at critical points
• Measure in the
and record procedures.
tympanic Each
(aural) temperature procedure sec-
accurately.
tion refers you to a specific
• Measureevaluation
and record temporalsheet in theaccurately.
temperature workbook.
• Measure and record radial pulse to an accuracy within 62 beats per minute.
4. Evaluation Sheets (Workbook): Each evaluation sheet contains a list of cri-
Vital Signs
• Count and record respirations to an accuracy within 61 respiration per minute.
teria on which you will be tested when you have mastered a particular
• Measure and record apical pulse to an accuracy within 62 beats per minute.
procedure. Make sure that your
• Measure performance
and record blood pressure to meets
an accuracythe standards
within set.reading.
62 mm of actual
When you feel you have mastered
• State the normal a particular
range procedure,
for oral, axillary, sign thepulse;
and rectal temperature; evalua-
respirations; and systolic and
tion sheet and give it to your instructor. Your instructor will grade you by
diastolic pressure.
• Define, pronounce, and spell all key terms.
using the listed criteria and checking each step against your performance.
In addition to these components, you will also find a References list at the
ChapTer ObjeCTives end of the textbook. For Key Termsinformation about the topics discussed,
additional
After completing this chapter, you should be able to: refer to these references. apical pulse (ape9-ih-kal) character homeostasis (home 0-ee-oh-
Finally, you will notice various icons
apnea (ap9-nee 0-ah) throughout the textbook.
Cheyne-Stokes Their
(chain9-stokes 0) pur-stay9-sis)
• List the five main vital signs. hypertension
pose is to accentuate particular
arrhythmiafactors or denote specific
(ah-rith9-me-ah) types of knowledge.
clinical thermometers
Icons
• Convert Fahrenheit to Celsius, or vice versa. aural temperature cyanosis hyperthermia (high-pur-therm9-
The icons and their meanings are: ee-ah)
• Read a clinical thermometer to the nearest two-tenths of a degree. axillary temperature diastolic (die 0-ah-stall9-ik)
hypotension
Science Skill
• Measure and record oral temperature accurately.
Observe Standard Precautions
blood pressure dyspnea (dis(p)9-nee 0-ah)
Precaution Science hypothermia (high-po-therm9-
bradycardia (bray9-dee- electronic thermometers
• Measure and record rectal temperature accurately. Instructor’s Check—Call Instructor
car 9-dee-ah) at This Point
fever
Career Information
ee-ah)
Icons are used throughout the text to high- oral temperature

Check Career
• Measure and record axillary temperature accurately. bradypnea (brad 0-ip-nee9-ah)

Safety—Proceed with Caution Communications Skill
light specific pieces of information. An icon
• Measure and record tympanic (aural) temperature accurately.
Safety Comm
438
OBRA Requirement—Based on Federal Law Technology
• Measure and record temporal temperature accurately. Technology
for Nurse Assistant

OBRA
key is presented at the beginning of each

• Measure and record radial pulse to an accuracy within 62 beats per minute. HIPAA
Health Insurance Portability
and Accountability Act
• Count and record respirations to an accuracy within 61 respiration per minute. Math Skill
part to reinforce the meaning of the icons.
• Measure and record apical pulse to an accuracy within 62 beats per minute.
Math 09511_ch16_hr_438-469.indd 438
Legal Responsibility Electronic Health Records

30/07/15 9:39 PM
Legal EHR
• Measure and record blood pressure to an accuracy within 62 mm of actual reading.

• State the normal range for oral, axillary, and rectal temperature; pulse; respirations; and systolic and
diastolic pressure.
• Define, pronounce, and spell all key terms.
09511_ch01_hr_002-029.indd 3 23/07/
Key Terms
apical pulse (ape9-ih-kal) character homeostasis (home 0-ee-oh-
Key Terms
stay9-sis)
apnea (ap9-nee 0-ah)
arrhythmia (ah-rith9-me-ah)
Cheyne-Stokes (chain9-stokes 0)
clinical thermometers hypertension Key terms highlight the critical vocabu-
aural temperature cyanosis hyperthermia (high-pur-therm9-
ee-ah)
lary words you will need to learn. Pro-
axillary temperature diastolic (die 0-ah-stall9-ik)
blood pressure dyspnea (dis(p)9-nee 0-ah)
hypotension nunciations are also included for the
bradycardia (bray9-dee- electronic thermometers
hypothermia (high-po-therm9-
ee-ah)
harder-to-pronounce words. These terms
car 9-dee-ah) fever
bradypnea (brad 0-ip-nee9-ah)
oral temperature are highlighted within the text where
438
they are defined. You will also find most
of these terms listed in the Glossary sec-
tion. Use this listing as part of your study
09511_ch16_hr_438-469.indd 438 30/07/15 9:39 PM
and review of critical terms.
xv
xvi H ow to U se T his T e x tbook
C a r e e r s i n h e a lt h C a r e 81
tODay’s researCh
tOmOrrOW’s health Care
Memories Restored
by Flipping a Switch?
Today’s Research:
Do you wish that you could forget the time you dropped a
plate of spaghetti in your lap at a restaurant or that you could
correct lever for a longer period of time. In order to evaluate if
memory could be suppressed, the researchers gave the rats
Tomorrow’s Health Care
always remember the names of people you have met before? a drug that blocked the nerve-cell activity and caused the
Wouldn’t it be nice to be able to turn memories on and off rats to forget the task. A prosthetics (artificial devices) team Today’s Research: Tomorrow’s Health Care
with the flip of a switch? You could eliminate all of your bad
memories and improve your good ones. Some day this may
then created an artificial system that duplicated the pattern of
interaction between CA3 and CA1 in the hippocampus. When
boxes are located in each chapter. These
be possible. this system was inserted into the animals, and the brain cells commentaries help you learn about the
Theodore Berger, a biomedical engineer at the Univer- were stimulated with the correct pattern, long-term memory
sity of Southern California, has figured out how to manipulate returned. A final discovery was that when the prosthetic hip- many different types of research occur-
pocampus with its electrodes was implanted in animals with
brain cells in rats so that they can be activated or sup-
pressed. The study involved an area of the brain called the normal function, the device strengthened the memory being
ring today. If the research is successful, it
hippocampus, a region crucial for memory formation. The created. Additional research is now being conducted with pri- may lead to possible cures and/or better
team inserted electrical probes in the hippocampus. They mates and more advanced tasks.
then taught rats to learn which of several levers had to be If research is successful, it might be possible to create a methods of treatment in the future for a
pressed to receive a reward. During the learning process, prosthetic that can be implanted in humans. This could help
the researchers recorded changes in the brain activity of the victims of Alzheimer’s disease, stroke, or brain injury recover wide range of diseases and disorders. These
652 C h a p t e r 2 0
rats between two major internal divisions of the hippocam-
pus, sub-regions known as CA3 and CA1. Through research,
memory that has been lost and could improve mental function.
In addition, if the prosthetic can be used to suppress memories,
boxes of information also highlight the fact
they learned these sub-regions interact to convert short-term the device might be a method for treating individuals with
Key terms that health care changes constantly because
memory into long-term memory. They were also able to pin- post-traumatic stress disorder or other psychiatric conditions(COnT.)
point the pattern of nerve-cell activity involved in creating a such as fears caused by a previous memory. Even though this
hyperglycemia
of new ideas and technology.
polyuria specific gravity
solid memory. The scientists then used the electrical probes research will require many more years of (high study0-purr-gly-see9-me-ah)
due to the reagent strips typing and crossmatch
to stimulate the nerves in the same pattern and found that the complex nature of memory in humans, if ithypoglycemia
is successful it will
rats’ performance improved and the rats could remember the be a major breakthrough for many individuals. refractometer urinalysis (your9-in-al 0-ee-sis)
(high 0-poh-gly-see9-me-ah) (ree-frack-tum9-ee-ter) urinary sediment
leukocytes resistant urinometer
equipment and computers. They must also be adept at • Biotechnology Industry Organization microscope sensitive venipuncture
preparing reports, compiling statistics, and testifying 1201 Maryland Avenue SW, Suite 900 (oh 0-lih-goo9-ree-ah)
oliguria skin puncture
in trials or hearings. Washington, DC 20024
Internet address: www.bio.org
146 C h a p t eSources
Additional r 7
of Information
Career Highlights
• American Academy of Forensic Sciences
7:1 basic structure
410 North 21st Street
• Biotechnology Institute
1201 Maryland Avenue SW, Suite 900
• Inherited:
Washington,
cally;
transmitted
examples include
careerhighlights
DC 20024from parents to child geneti-
color blindness, hemophilia,
Medical, or clinical, laboratory personnel work under Clinical Laboratory Improvement Amendment (CLIA) of
Internet address: www.biotechinstitute.org
Career Highlights appear in the Special Health
Colorado Springs, CO 80904 cystic fibrosis, and Down syndrome the supervision of doctors, usually pathologists. They 1988. CLIA established standards, regulations, and per-
of the human body
Internet address: www.aafs.org • Federation of American Societies for Experimental
• Infectious: caused by a pathogenic
are important members of the health care team.
Career (germ produc-
formance requirements based on the complexity of a test
Care Skills
• American chapters.
Institute BySciences
of Biological reading and understand- Biology
ing)
They perform laboratory tests on body tissues, fluids, and the risk factors associated with incorrect results. The
9650organism
Rockvillesuch
Pike as a bacteria
and orcellsvirus;
to aid examples
in the detection, diagnosis, and treatment of purpose is to ensure quality laboratory testing. Levels of
Objectives
ing 1444 I Street NW, Suite 200
the material presented in these boxes, you willinclude
Bethesda,theMDcommon
20814 cold, hepatitis,
disease. Levelsandofsexually
personnel are the technologist, technician, complexity include waived tests, moderately complex
Washington, DC 20005 transmitted infections laboratory assistant, and phlebotomist. Clinical laboratory sci- tests including provider performed microscopic proce-
After completing this section, you should be able to: Internet address: www.faseb.org
learn theaddress:
Internet educational
www.aibs.org requirements of each profes-
•• Degenerative:
Pharmaceuticalcaused
entists (CLS) or medical technologists (MT) perform more
by a deterioration
dures (PPMP), and highly complex tests. Each of these
• • Label a diagram
American of the
Society formain parts of aand
Biochemistry cell Molecular Research andcomplex testsofand
Manufacturers the func-
have aofbachelor’s or master’s degree. Clin- levels has different requirements for personnel and qual-
sion, potential
• Describe
Biology the places
basic function
(ASBMB) ofpart
of each employment,
of a cell and addition or structure of body tissuesical
America and organstechnicians
laboratory either by (CLT) or medical laboratory techni- ity control. Laboratories are certified by the U.S. Depart-
normal bodyNW,
950 F Street aging or 300
Suite lifestylecians
choices
(MLT) such
performaslessdietcomplex tests and usually have an ment of Health and Human Services (USDHHS) based on
tional11200tasks
• Compare Rockville
Rockville,
you
the four Pike,
MD 20852-3110
may
mainSuite 302
types ofhave to
tissue by perform
describing that are not
and exercise; examples
Washington, DC 20004include arteriosclerotic heart laboratory assistants perform
associate’s degree. Medical these levels. In addition, only Food and Drug Administra-
the basic function of each type disease
Internet(ASHD),
address:chronic basic laboratory
obstructive pulmonary tests and
dis-usually have specialized health sci- tion (FDA)–approved equipment or self-contained kits
specifically discussed
Internet address: www.asbmb.orgwithin the chapter.
• Explain the relationships among cells, tissues, organs,
www.phrma.org
ease (COPD), and osteoarthritisence education (HSE) training. Phlebotomists, or venipuncture may be used to perform waived tests. The FDA maintains
• and
American technicians, collect blood and prepare it for testing. They usu- an up-to-date listing of approved equipment and self-
systemsSociety for Clinical Pathology Other terms associated with disease include
ally have diagnosis,
1–2 years of on the job experience or specialized contained kits for waived tests at www.fda.gov in the
33 West Monroe Street, Suite 1600 stuDent:
• Define, pronounce,
Chicago, IL 60603 and spell all key terms etiology, andGoprognosis.
to the workbook and iscomplete
health
A diagnosis science the the
education
identifying (HSE) training. Some states require search for waived analytes (substances whose chemical
assignment sheet for
disease or stating Chapter
what it is. 3, Careers
Etiology in Health
laboratory
refers Care.
personnel
to the to be licensed or registered. Certification
cause components are being identified and measured). There-
Internet address: www.ascp.org can be obtained from the national Credentialing Agency for fore, medical laboratory assistants/medical assistants
of the disease. At times the etiology is known, such as
Introduction Laboratory Personnel (nCA), the American Society for Clinical
influenza being caused by a virus. For some(ASCP),
Pathology diseases, theAmerican Medical Technologists
or the
must follow all legal requirements before performing any
laboratory test. Some examples of waived tests, or tests
The human body is often described as an efficient, orga- cause is unknown or idiopathic. When a disease
Association is each
(AMT), causedof which has specific requirements. that can be performed by assistants if the agency where
nized machine. When this machine does not function by a prescribed treatment the etiologyAny iatrogenic.
is medical laboratory or physician office labora- they are working has a CLIA waiver certificate and if
correctly, disease occurs. Before understanding the dis- Examples include anemia caused by chemotherapy,
tory (POL) that or performs tests on human speci- the equipment or self- contained test kits are FDA
09511_ch03_hr_043-082.indd 81
low potassium levels caused by diuretic mens is regulated8/1/15
medication. by a11:48
federal
AM amendment, the approved, include:
ease processes, however, the health care worker must first Legal
understand the normal functioning of the body. A basic Prognosis refers to a prediction of the probable course
and/or the expected outcome of the • disease.
Most urinary reagent strip (dipstick) self-contained components to per- • Cholesterol monitoring
understanding of anatomy and physiology is therefore or reagent tablet tests form specimen/reagent interaction
necessary. Anatomy is the study of the form and struc- • Rapid streptococcal identification
and provide direct measurement
ture of an organism. Physiology is the study of the pro- Cells • Hematocrit and spun
microhematocrit
and readout • Gastric occult blood
cesses of living organisms, or why and how they work.
The basic substance of all life is protoplasm.
• ErythrocyteThis mate- rate • Blood glucose • Specific drug screening
Pathophysiology is the study of how disease occurs and sedimentation
rial makes up all living things. Although protoplasm is
(nonautomated) • Ovulation and pregnancy tests by • Specified automated blood
the responses of living organisms to disease processes.
composed of ordinary elements such as carbon, oxygen, visual color comparison chemistry analysis
Some different types of diseases include: • Hemoglobin: automated by
hydrogen, sulfur, nitrogen, and phosphorus, scientists
single analyte instruments with • Fecal occult blood • Triglyceride test
• Congenital: acquired during development of the are unable to combine such elements to create that char-
infant in the uterus and existing at or dating from acteristic called life. (continues )
birth; examples include club foot, cleft lip and/or Protoplasm forms the basic unit of structure and func-
palate, fetal alcohol syndrome, and spina bifida tion in all living things: the cell. Cells are microscopic
Related Health Careers

09511_ch20_hr_651-709.indd 652 13/08/15 3:46 pm
related health Careers

Note: A basic knowledge of human anatomy and physi- of related health careers are listed. The following health Related Health Careers appear in
ology is essential for almost every health care provider. career categories require knowledge of the structure and
However, some health careers are related to specific body function of the entire human body and will not be listed in Chapter 7, Anatomy and Physiology, and
systems. As each body system is discussed, examples specific body system units.
in other chapters that contain information
• Athletic Trainer • Pharmacy Careers Specific careers for cells and compo-
nents of body tissues include:
related to specific careers. By reviewing
• Emergency Medical Careers • Physician
• Medical Laboratory Careers • Physician Assistant
• Biochemist the information presented in these boxes,
• Medical Assistant • Surgical Technologist
• Biologist you will relate specific health careers to
• Medical Illustrator
• Cytologist specific body systems or chapter content.
• Forensic Scientist
• Nursing Careers
• Genetic Engineer
09511_ch07_hr_145-239.indd 146 6/19/15 6:19 PM
Athletic Trainer Gastroenterologist
Behavioral Disorder Counselor Health Educator
Dietetic Assistant Naturopathic Physician
Dietetic Technician Personal Trainer
Dietitian H ow to U se
Wellness CoachT his T e x tbook xvii
Information Sections 11:1 Fundamentals of Nutrition

• Osteoporosis: condition in which bones become
porous (full of tiny openings) and break easily; one
cause is long-term deficiencies of calcium, magne-
The initial numbered sections for each People enjoy food and like to discuss it. Most people know sium, and vitamin D
that there is an important relationship between food and • Diabetes mellitus: metabolic disease caused by an
topic in this text are information sec- good health. However, many people do not know which insufficient secretion or use of insulin, leading to
tions which explain the basic facts of nutrients are needed or why they are necessary. They are
not able to select proper foods in their daily diets in order
an increased level of glucose (sugar) in the blood;
heredity, obesity, lack of exercise, and diets high in
the topic, why you would need this to promote optimum health. Therefore, it is important for carbohydrates and sugars contribute to individuals
every health care worker to have a solid understanding of
information, and how the information basic nutrition. With this understanding, the health care
developing this disease
• Malnutrition: the state of poor nutrition; may be
is applied to various health care fields. worker can both practice and promote good nutrition.
caused by poor diet or illness. Symptoms include
Nutrition includes all body processes relating to
The information sections are des- food.,These include digestion, absorption, metabolism, fatigue, depression, poor posture, being overweight
or underweight, poor complexion, lifeless hair, and
ignated using a numbering system that circulation, and elimination. These processes allow the
irritability (Figure 11–1). It can cause deficiency
body to use food for energy, maintenance of health, and
correlates to the chapter number. growth. Nutritional status refers to the state or condi- diseases, poor muscular and skeletal development,
tion of one’s nutrition. The goal is, of course, to be in a
state of good nutrition and to maintain wellness, a state
of good health with optimal body function. To do this,
one must choose foods that are needed by the body, not
just foods that taste good.
Nutrition plays a large role in determining height,
weight, strength, skeletal and muscular development,
physical agility, resistance to disease, appetite, posture,
complexion, mental ability, and emotional and psycho-
logical health. The immediate effects of good nutrition
664 Chapter 20 include a healthy appearance, a well-developed body,
a good attitude, proper sleep and bowel habits, a high
Procedure Sections
energy level, enthusiasm, and freedom from anxiety.
PROCEDURE 20:2C In addition, the effects of good nutrition accumulate
throughout life and may prevent or delay diseases or
Streaking an Agar Plate conditions such as the following:
Procedure sections provide step-by-step
Equipment and Supplies • Hypertension: high blood pressure; may be caused
Agar plate with correct medium, specimen for direct smear, by an excess amount of fat or salt in the diet; caninstructions
lead on how to perform the pro-
label, pen or marker and or computer, incubator, disposable
gloves, infectious-waste bag cedure outlined in the initial information
to diseases of the heart, blood vessels, and kidneys
• Atherosclerosis: condition in which arteries are nar-
Procedure
rowed by the accumulation of fatty substances section
on at the start of each topic. Practice
1. Assemble equipment.
their inner surfaces; thought to be caused by athese
diet procedures until you perform them
2. Wash hands. Put on gloves.
high in saturated fats and cholesterol; can lead to Figure 11–1 This child shows many of the signs of severe
CAution: Observe standard precautions while
handling any culture specimen. heart attack or stroke correctly andCourtesy
malnutrition. proficiently.
of the Centers for Disease Control Public Health Image Library
Precaution
3. Remove the applicator containing the culture specimen
from its container. Hold it by the nonapplicator end. Take
care to avoid contaminating the applicator tip. Look at the
tip to be sure it is still moist. 09511_ch11_hr_297-315.indd 298 24/06/15 2:02 am
Figure 20–11a Hold the agar plate firmly in one hand while
note: If the specimen is dry, the organisms have probably streaking it with the specimen.
died, and the results will not be accurate.
4. The agar plate is made up of two parts: the lower disk, 1st Streak
which contains the agar, and the upper lid. Open the agar
plate. Take care not to touch the inside of the plate. Invert
the lid; that is, place the lid with the top against the counter.
In this way, the inside of the lid faces up and stays clean.
note: The agar plate can also be placed upside down,
with the agar on top. The agar plate should then be lifted. 4th 2nd
The lid will remain on the table, with the inside facing up. Streak Streak
5. Hold the plate firmly in one hand (Figure 20–11A) or place

it on a flat surface.
6. Starting at the top of the agar, gently place the applica-
tor tip in one corner. Using a rotary motion, turning the
top of the tip so that all sides of the tip touch the agar,
go from side to side approximately one-quarter of the way 3rd Streak
down the plate. To cover the second quadrant of the plate, Figure 20–11b A sample streaking pattern.
turn the plate one-quarter turn and repeat the side-to-side
motion of the applicator tip, crossing the first quadrant two
CAution: Be gentle. Do not break into the agar.
to three times. Turn the plate one-quarter turn and use
the same motion to cover the third quadrant. To cover the
fourth quadrant, turn the plate one-quarter turn, and cross Safety
into the third quadrant one or two times. note the sample note: An inoculating loop can also be used to streak the
streaking pattern in Figure 20–11B. This streaking method agar. After each quadrant is streaked, the loop is placed
helps isolate the colonies of organisms in the fourth quad- in a flame and cooled. Use the method the laboratory or
rant (Figure 20–11C). physician prefers.
note: This is only one type of streaking pattern. Use the note: Cover the agar only one time in each area. Do not
streaking pattern preferred by your employer. go back over areas already covered.
09511_ch20_hr_651-709.indd 664 13/08/15 3:47 pm
xviii H ow to U se T his T e x tbook
Full-Color Photos and Illustrations

Illustrations are presented in full color and demonstrate Full-color photos are used throughout the text to
important health care concepts, including the inner illustrate important techniques you will be required to
workings of the body. Use these illustrations for review know and demonstrate when working within a health
while studying. care field.
Sacroiliac joint
Sacrum
lliac crest
C u lT u r a l D i v e r s i T y 277
• Learn more about the cultural and ethnic groups that • Recognize and promote the patient’s positive interac-
you see frequently. tions with family. Anterior
• Recognize and avoid bias, prejudice, and stereotyping. superior
• Be sensitive to how patients respond to eye contact,
• Ask questions to determine a person’s beliefs. iliacspace.
touch, and invasion of personal spine
• Evaluate all information before forming an opinion. • Respect spirituality, religious beliefs, symbols, and
rituals.
• Allow patients to practice and express their beliefs as
Ilium Coccyx
much as possible.
stud ent: Go to the workbook and complete the
Ischial spinethat you are not expected to adopt anoth-
• Remember assignment sheet for Chapter 9, Cultural Diversity.
er’s beliefs, just accept and respect them.
Pubis Acetabulum
ChapTerIschium
9 summary Obturator foramen
Because health care providers work with and care for manyPubic about a person or subject that is formed without reviewing
symphysis
different people, they must be aware of the factors that cause facts or information. Stereotyping occurs when an assumption
Figure 7–22 Anterior view of the pelvic girdle.
each individual to be unique. These factors include culture,
ethnicity, and race. Culture is defined as the values, beliefs,
is made that everyone in a particular group is the same. Bias,
prejudice, and stereotyping are barriers to effective relation-
attitudes, languages, symbols, rituals, behaviors, and customs ships with others. Health care providers must be alert to these
unique to a group of people and passed from one generation barriers and make every effort to avoid them.
to the next. Ethnicity is a classification of people based on An understanding of cultural diversity allows health care
national origin and/or culture. Race is a classification of people providers to give holistic or transcultural care; that is, care that
based on physical or biological characteristics. The differences provides for the well-being of the whole person and meets not
among people resulting from cultural, ethnic, and racial factors only physical, but also social, emotional, and mental needs. Figure 16–14B While taking a temperature, hold the probe of the
are called cultural diversity. Health care providers must show
sensitivity, or recognize and appreciate the personal charac-
Some areas of cultural diversity include family organization,
language, personal space, touching, time orientation, eye con-
electronic thermometer in place.
teristics of others, because America is a multicultural society. tact, gestures, health care beliefs, spirituality, and religion.
Bias, prejudice, and stereotyping can interfere with ac- The key to respecting cultural diversity is to regard each
ceptance of cultural diversity. A bias is a preference that inhib- person as a unique individual. Health care providers must learn
its impartial judgment. A prejudice is a strong feeling or belief to appreciate and respect the personal characteristics of others.
inTerneT searChes
Use the search engines suggested in Chapter 12:9 in this text 5. Family structure: Search words such as extended or
Internet Searches
to search the Internet for additional information about the fol- nuclear family, patriarchal, and/or matriarchal.
lowing topics: 6. Health care beliefs: Search by country of origin for health
Internet Searches can enhance your com-
1. Cultural diversity: Search words such as culture, ethnic- care beliefs, or search words such as yin and yang or
shaman.
prehension of the chapter information by
ity, and race to obtain additional information on character-
istics and examples for each.
7. Alternative health care: Search for additional information offering you the chance to research infor-
2. Ethnic groups: Search countries of origin for information
on different ethic groups or on your own ethnic group; for
on chiropractor, homeopath, naturopath, hypnotist, hypno-
therapy, meditation, biofeedback, acupuncture, acupres-
mation on the chapter topics.
example, if you are German–Irish, search for information sure, therapeutic touch, yoga, tai chi, and/or faith healing.
on both Germany and Ireland. (Refer to Table 1–8 in Chapter 1.)
3. Cultural assimilation and acculturation: Search for 8. Spirituality and religion: Search for additional informa-
additional information on these two topics. tion on spirituality; use the name of a religion to obtain
more information about the beliefs and practices of the
4. Bias, prejudice, and stereotyping: Use these key words
religion.
to search for more detailed information.
09511_ch09_hr_262-278.indd 277 6/22/15 3:28 PM

278 ChapTer 9
Review Questions review QuesTiOns

1. Differentiate between culture, ethnicity, and race. 7. Differentiate between spirituality and religion.
Review Questions enhance your com- 2. Name five (5) common ethnic groups and at least two
(2) countries of origin for each group.
8. Why is it important for a health care worker to have an
awareness of a patient’s religious beliefs while caring for a
prehension of chapter content. After you 3. Create examples of how a bias, prejudice, and stereotype
may interfere with providing quality health care.
patient who is dying?
9. You are preparing a patient for a surgical procedure and
have completed the chapter reading, try to 4. Describe your family structure. Is it a nuclear or extended know that all jewelry must be removed. The patient is
wearing a bracelet and states she is not allowed to remove
family? Is it patriarchal or matriarchal or neither? Why?
answer the review questions at the end of 5. Do you feel acculturation occurs in the United States? Why
it. What do you do?
10. List six (6) specific ways to respect cultural diversity.
the chapter. If you find yourself unable to or why not?
6. Describe at least three (3) different health care practices Note: The cultural assessment questions presented in this unit
answer the questions, go back and review that you have seen or heard about. Do you feel they are
beneficial or harmful? Why?
were adapted from Joan Luckmann’s Transcultural Communi-
cation in Health Care (2000), which adapted them from Fong’s
the chapter again. CONFHER model and Rosenbaum.
H ow to U se T his T e x tbook xix
Supplements at a Glance
Supplement What It Is What’s In It
Teacher’s Resource Kit Three-Ring Binder Classroom Management Activities
ISBN-13: 978-1-3055-0968-9 Also available on Instructor Resources Lesson Plans
CD-ROM or Instructor Companion Ready-to-Use Tests and Quizzes
Website
Classroom Activities
Internet Activities
Leadership Development Activities
Applied Academics
Clinical Rotations
Resources
Visual Aids
Instructor’s Manual Print product Answers to Student Workbook Assignment Sheets
ISBN-13: 978-1-3055-0967-2 Also available on Instructor Resources New! Answers to end-of-chapter review questions
CD-ROM or Instructor Companion
Website
Workbook Print product Assignment Sheets for student review
ISBN-13: 978-1-3055-0965-8 Evaluation Sheets for judging student performance
for each procedure in the textbook
Instructor Companion Website Online instructor resources; Web Computerized test banks powered by Cognero®
access via login.cengage.com software
Slide presentations in PowerPoint®
Image Library
Animations
Standards mapping grid
Electronic Instructor’s Manual, and Teacher’s
Resource Kit
MindTap to Accompany DHO Accessed via a web code. The learning path allows flexibility to meet diverse
ISBN-13: 978-1-3055-0954-2 classroom needs and learning styles.
Chapter level simulations help students apply knowl-
edge and elevates their level of learning.
MindTap allows instructors to adapt the Table of
Contents to their course, while a customizable
Learning Path allows instructors to select desired
chapter sections and activities.
Student Online Companion Free online student resources; Web Audio podcasts of medical terminology
access via www.cengagebrain.com. Animations of anatomical and physiological
Look for the Free Materials tab. processes
Acknowledgments
This eighth edition of Health Science is dedicated to Bethanne Reichard Bean, MLS, CLSup, BSMT (ASCP)
my daughters, Karen Simmers-Nartker and Sharon Medical Science Academy Coordinator/Instructor,
Simmers-Kobelak, who have worked so hard the past Grades 6–12
two years as we revised both this textbook and Practi- State of Florida Licensed Clinical Laboratory
cal Problems in Mathematics for Health Science Careers. Supervisor of Microbiology, Hematology,
Even though they are parents of young children and Clinical Chemistry, Molecular Pathology, Serology,
work full-time, they devoted many hours to working on and Immunohematology
these projects. School District of Palm Beach County, Florida
The author would like to thank everyone who par-
Kimberly Davidson, RN, BSN, MEd
ticipated in the development of this text, including:
Level 1 Tech Prep Health Occupations Instructor
Nancy L. Raynor, former Chief Consultant, Health Madison Comprehensive High School
Occupations Education, State of North Carolina, Mansfield, Ohio
who served as a consultant and major mentor in the
Staci Gramling Gardner, RRT
initial development of this textbook
Health Science Instructor
Dr. Charles Nichols, Department Head, and Ray Gadsden City High School
Jacobs, Teacher Educator, Kent State University, Gadsden, Alabama
who provided the encouragement I needed when I
Alice Graham, RN
wrote the first edition of this textbook
Coordinator and Instructor
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ungovernable. The Mediterranean, Italy, Rome, blue skies and
classical cities,—what are they all to me?
Give me back one hour of Scotland;
Let me see it ere I die.
They conveyed him back by slow stages, seeing this and that
continental sight on his homeward-route, but hardly knowing what
he saw. He was in London again for a week or two in June and July
1832, attended medically in a hotel in Jermyn Street. Brought thence
by sea to Edinburgh, he passed a night, a day, and another night, in a
hotel in St. Andrew Square, in a state of utter unconsciousness; and
on the 11th of July they took him to Abbotsford. On their way thither
through the old familiar scenery he began to recognise places and
objects, and to mutter their names,—Gala Water, Buckholm,
Torwoodlee; and, when they approached Abbotsford itself, and he
caught sight of its towers, he sprang up in such a state of excitement
that they could hardly hold him in the carriage. “Ha! Willie Laidlaw!
O man, I have often thought of you,” were his first words, after his
old friend and amanuensis Laidlaw, who was waiting in the porch,
had assisted the rest in carrying him into the house, and seating him
in a chair in the dining-room. The return of consciousness which this
recognition signified became more and more marked, at least at
intervals, in the two months and ten days through which he still
lingered. He talked with those of his family who were about him,
could be shifted from room to room or even wheeled in a Bath chair
through parts of his grounds, and could listen to readings and seem
to take an interest in them. Once he insisted on being placed at his
writing-table, with paper, pens, and ink before him in the
accustomed order, and wanted to be left to himself; but, when the
pen had been put into his hand and his fingers refused to hold it,
tears trickled down his cheeks, and he gave up the attempt. There
were, as often in such cases of brain-paralysis, some days of almost
frantic vehemence, when it was painful to be near him; but these
were succeeded by a feeble quietude and a gradual ebbing-away of
life. On the 21st of September 1832, with the ripple of the Tweed
heard by those who stood round his bed, Sir Walter Scott, then only
in the sixty-second year of his age, breathed his last.
In the Diary itself the narrative of those closing years of Scott’s
life is broken short at the point where they were bringing him back
from Italy as a dying invalid. The last few months are a total blank in
the Diary; where, indeed, the entries for the later years of the
included seven are scantier and more intermittent than those for the
earlier. But it is not solely as an exact autobiographic record of the
incidents of so many memorable years of a memorable life that the
Diary is now of interest. Implicated in that main interest, and
catching the attention of the reader again and again as he advances
through the pages, are certain recurring particular informations as to
Scott’s character and ways which possess an independent interest,
and may be reverted to separately.
Bound up, for example, with the proofs furnished by the Diary of
Scott’s prodigious literary industry, there is plenty of minute
information as to his habits of composition and his rate of
composition. I do not like that word “composition” in any such
application, thinking it a miserable word for the description of the
process by which a great writer marshals the contents of his mind
and commits them to paper; but the word is current, and may serve
for the nonce. Well, Scott’s rate of composition was about the fastest
known in the history of literature. Of all his predecessors in the
literary history of the British Islands, Shakespeare seems to have
been the likest to him in this particular of fluent facility and swiftness
of production. “His mind and hand went together,” is the well-known
report concerning Shakespeare by his literary executors and editors:
“his mind and hand went together, and what he thought he uttered
with that easiness that we have scarce received from him a blot in his
papers.” One has an impression, however, that Shakespeare, with all
his facility when he had the pen in his hand, had it less constantly in
his hand, was less “eident” in the use of it (as our good northern
phrase goes), than Scott,—whether because he had less actual need
to be “eident,” or because verse, which was Shakespeare’s main
element, is intrinsically more difficult, takes more out of a man in a
given time, and so is less favourable to “eidency,” than the prose
element in which, latterly, Scott worked all but exclusively. At all
events, “eidency” and “facility” taken together, the result, in the mere
matter of quantity, was larger from Scott’s industry than from
Shakespeare’s. But it is with the “facility” that we are now concerned,
and with the proofs of this “facility” which are furnished by the
Journal in particular. The mere look of the handwriting is one of
these,—that rapid currente calamo look, without hesitation, and with
hardly an erasure, stoppage to point, or any such thing, and with the
words almost running into each other in their hurry, which is
familiar to all who have seen facsimile reproductions of any portions
of the copy of Scott’s novels, when they were written with his own
hand, and not dictated. That, however, is a characteristic common to
all his writings; and the specific interest of the Diary in this
connection is that it gives us definite information as to the amount of
writing per day which Scott usually got through in his currente
calamo style. In entry after entry there is note of the number of
pages he had prescribed to himself as a sufficient day’s “task” or
“darg,” with growls when for any reason he had fallen short of it, and
smiles of satisfaction when he had exceeded it; and from one entry
we ascertain that his maximum per day when he was in good vein
was eight pages of his own close manuscript, making forty pages of
the usual type in which his copy was set up by the printers. One can
compute the difference between that rate and any other rate of which
one may happen to have knowledge or experience; but there is no
need to conclude that Scott’s rate is to be passionately desired or
universally aimed at, or that, because it suited Scott, it would suit
others. On the contrary, one sees some disadvantages, even in Scott’s
own case, counterbalancing the advantages of such extreme rapidity.
He was aware of the fact himself; and he once quotes, with some
approbation, an admirable maxim of Chaucer on the subject:—
“There n’ is no werkman, whatsoever he be,
That may both werken well and hastily.”
That Scott was an exception,—that he was, like Shakespeare, one of

those workmen who could work both well and hastily,—was owing
doubtless to the fact that, in this also resembling Shakespeare, he
brought always to the act of writing a mind already full of matter,
and of the very kinds of matter required for his occasions. One has
but to recollect the extraordinary range and variety of his readings
from his earliest youth, the extraordinary range and variety also of
his observations of men and manners, and the extraordinary
retentiveness of his memory, to see that never since he had begun
authorship could he have had to spin, as so many have to do, the
threads of his ideas or imaginations out of a vacuum. At the same
time, and this notwithstanding, there is something more to be said,
when the comparison is between Scott as an exceptionally rapid
worker and Shakespeare as the same. Scott had a standard of the
kind of matter that would answer for the purposes of his literary
productions; and, though a very good standard, it was lower than
Shakespeare’s standard for his writings. When Shakespeare was in
the act of writing, or was meditating his themes by himself in the
solitude of his chamber, or in his walks over the fields, before he
proceeded to the act of writing, we see his mind rolling within itself,
like a great sea-wash that would rush through all the deeps and
caverns, and search through all the intricacies, of its prior structure
and acquisitions,—so ruled and commissioned, however, that what
the reflux should fetch back for use should not be any wreckage
whatsoever that might be commonly relevant and interesting, but
only things of gleaming worth and rarity, presentable indeed to all,
but appreciable in full only by kings and sages. Hear, on the other
hand, in Scott’s own words, the definition of what satisfied him in his
dealings with the public. “I am sensible,” he wrote, “that, if there be
anything good about my poetry, or prose either, it is a hurried
frankness of composition which pleases soldiers, sailors, and young
people of bold and active disposition.” That Scott was grossly unfair
to himself in this under-estimate will be the verdict now of universal
opinion; and I shall have to touch again upon that point presently.
Meanwhile there is one other difference to be noted between the two
men in respect of that very circumstance of their marked similarity
in one characteristic which has led us to view them together.
Shakespeare’s boundless ease and fluency in writing did not prevent
perfection in his literary execution. His grammar, with all its
impetuosity and lightness of spring, is logical and accurate to the
utmost demands of the most fastidious English scholarship; and,
though he would have repudiated with scorn the name “stylist,”
invented of late as a title of literary honour by some of our critics,
and it would be profane to think of him under that execrable and
disastrous appellation, he wrote always with the sure cunning of a
disciplined artist in verbal expression,—an artist so highly self-
disciplined that his art in such matters had become an instinct.
Scott’s habitual style, on the other hand,—his style when he is not
strongly moved either by vehement feeling or by high poetic
conception,—is a kind of homely and comfortable slipshod,
neglectful of any rule of extreme accuracy, and careless even of the
most obvious grammatical solecisms. It is not exactly with reference
to this difference between himself and Shakespeare that there occurs
in one passage in his Diary a protest against being compared with
Shakespeare at all. But the protest is worth quoting. “Like
Shakespeare!” he exclaims, noticing the already formed habit of this
perilous comparison among his most ardent admirers in his own
lifetime,—“like Shakespeare! Not fit to tie his brogues!” It was the
superlative of compliment on Scott’s side; but its very wording may
be construed into a certain significance in connection with that point
of dissimilarity between the two men to which I have just adverted.
Shakespeare never wore “brogues.” In our present metaphorical
sense, I mean; in the literal sense, I would not be sure but he may
have found such articles convenient quite as often as Scott did. There
were muddy roads about Stratford-on-Avon as well as about
Abbotsford.
It would be wrong not to mention, however briefly, the
confirmation furnished by the Journal of all our previous
impressions of Scott’s high excellence among his fellow-men, not
only in the general virtues of integrity, honour, courage, and
persevering industry, but also in all those virtues which constitute
what we call in a more particular sense goodness. “Great and good”
is one of our common alliterative phrases; and it is a phrase which
we seem to require when we would characterise the kind of human
being that is entitled to supreme admiration. We feel that either
adjective by itself would be inadequate in such a case, but that the
doubling suffices. Another of our alliterative phrases, nearly the
same in meaning at root, is “head and heart.” Only when there is a
conjunction in a human being of what we call “heart” with what we
call “intellect” are we quite satisfied even in cases of ordinary
experience; and only when there is the conjunction of “great heart”
with “great intellect” do we bow down with absolute veneration
before this man or that man of historical celebrity. Common and
simple though this word “heart” is, there is a world of unused
applicability in it yet in many directions. In the criticism of literature,
for example, it supplies a test that would make havoc with some high
reputations. There have been, and are, writers of the most
indubitable ability, and of every variety of ability, in whose writings,
if you search them through and through, though you may find
instruction in abundance, novelties of thought in abundance, and
amusement in abundance, you will find very little of real “heart.”
There is no such disappointment when you turn to Scott.
Benevolence, charitableness, tolerance, sympathy with those about
him in their joys and their sorrows, kindly readiness to serve others
when he could, utter absence of envy or real ill-will,—these are
qualities that shine out everywhere in his life and in the succession of
his writings, and that receive, though they hardly need, additional
and more intimate illustration in his Journal. Positively, when I
contemplate this richness of heart in Scott, and remember also how
free he was all through his life from those moral weaknesses which
sometimes accompany and disfigure an unusually rich endowment in
this species of excellence,—for, born though he was in an old Scottish
age of roughish habits and not over-squeamish speech, and carrying
though he did the strong Scottish build of that age, and somewhat of
its unabashed joviality, to the very last, his life was exemplary
throughout in most particulars of personal conduct,—positively, I
say, with all this in my mind, I can express my feeling about Scott no
otherwise than by declaring him to have been one of the very best
men that ever breathed.
Of the interest of the miscellaneous contents of the book, as
including individual incidents in Scott’s life, sketches of the
physiognomies and characters of his Edinburgh contemporaries and
London contemporaries, descriptions of scenes and places, curious
Scottish and other anecdotes, literary criticisms, and expressions of
Scott’s opinions on public questions and on men and things in
general, no adequate idea can be formed except from itself. As to
Scott’s opinions on all the various questions, public or private, on
which he had occasion to make up his mind and express what he felt,
we may venture on one general remark. They are shrewd opinions,
and often or generally just,—the judgments of a man of strong
natural sagacity, and mature business-experience, adhering in the
main to use and wont, but ready for an independent consideration of
exigencies as they arose, and for any clear and safe improvement.
Even in politics, though his partisanship in that department was
obdurate, avowed, unflinching, and sometimes uproarious, his
shrewdness in the forecast of what was possible, or his private
determination in favour of what he thought just and desirable, led
him sometimes,—especially where Scottish nationality was
concerned, and the Thistle seemed to be insulted,—into dissent from
his party, and the proclamation of opinions peculiarly his own. It is
when we leave the plain ground of such practical and everyday
questions, and either ascend to those higher levels, or descend to
those deeper, at which the human intellect finds its powers more
hardly tasked,—it is then that we observe what is usually reckoned a
defect in Scott in comparison with many who have been far inferior
to him in other intellectual respects. There was little in his mind of
what may be called the purely noetic organ, that faculty which
speculates, investigates, deals with difficult problems of science or
philosophy, and seeks in every subject for ultimate principles and a
resting-ground of final conclusions. He either refrained from such
exercises of mind entirely, or was content with proximate and easily
accessible axioms. Even in literary criticism, where he might be
supposed to have been most at home, it is sagacious extempore
judgments that he offers, honest expressions of his own immediate
likings or dislikings, rather than suggestions or deductions from any
code of reasoned principles. So in matters of higher and more
solemn concern. From that simpler kind of philosophy which has
been defined as a constant Meditation of Death Scott did not refrain,
because no good or serious man can. There is evidence in his Journal
that in his solitary hours he allowed himself often enough to lapse
into this profoundest of meditations, and rolled through his mind the
whole burthen of its everlasting mysteries. But the inscrutable for
Scott, in this subject as in others, began at a short distance from his
first cogitations or his inherited creed. “I would, if called upon, die a
martyr for the Christian Religion,” he writes once in his Diary; and
no one can doubt that the words were written with the most earnest
sincerity. But, when we interpret them duly by the light of other
passages, and of all that we know independently, it is as if we saw
Scott standing upright with flushed face and clenched hands, and
saying to those about him who might want to trouble him too much
on so sacred a subject,—“This is the faith that has been transmitted
to us from far-back generations; this is the faith in which millions of
abler men than I am, or than you are, have lived and died; I hold by
that faith, without seeking too curiously to define it or to discuss its
several tenets; and, if you come too near me, to pester me with your
doubts and questionings, and new inquiries and speculations, and all
the rest of your clever nineteenth-century metaphysics, I warn you
that the soul of all my fathers will rise in me, and I shall become
dangerous.” In plainer words, on this subject, as on others, it was in
Scott’s constitution to rest in that kind of wisdom which declines
thinking beyond a certain distance.
Here, again, and in a new connection, we come round to
Shakespeare. In him, no one needs to be reminded, the noetic faculty
existed in dimensions absolutely enormous, working wonderfully in
conjunction with his equally enormous faculty of imagination, and
yet with the incessant alertness, the universal aggressiveness, and
the self-enjoying mobility, of a separate mental organ. Hence those
glances from heaven to earth and to the underworld which earth
conceals, those shafts of reasoned insight into the roots of all things,
those lightning gleams of speculation to its last extreme, that wealth
of maxims of worldly prudence outrivalling and double-distilling the
essence of all that is in Bacon’s Essays, those hints and reaches
towards an ultimate philosophy both of nature and of human life,
which have made Shakespeare’s writings till now, and will make
them henceforth, a perennial amazement. Well, after what has just
been said of Scott, are we bound, on this account, to give up the
customary juxtaposition of the two men? Hardly so, I think; for there
is a consideration of some importance yet in reserve. I will introduce
it by a little anecdote taken from the Journal itself.
People are still alive who have had personal acquaintance with
Miss Stirling Graham,—the lady who died as recently as 1877 at the
venerable age of ninety-five years, and who, some fifty or sixty years
before that, was famous in Edinburgh society for what were called
her mystifications. These consisted in her power of assuming an
imaginary character (generally that of an old Scottish lady), dressing
up in that character, appearing so dressed up unexpectedly in any
large company in a drawing-room, or even in the private study of
some eminent lawyer or judge, and carrying on a long rigmarole
conversation in the assumed character with such bewildering effect
that her auditor or auditors were completely deceived, and supposed
the garrulous intruder to be some crazy eccentric from a country-
house or some escaped madwoman. It was on the 7th of March 1828
that Sir Walter Scott witnessed, in the house of Lord Gillies, after
dinner, one of those “mystifications” of Miss Stirling Graham; and he
describes it in his Journal thus:—“Miss Stirling Græme, a lady of the
Duntroon family, from whom Clavers was descended, looks like
thirty years old, and has a face of the Scottish cast, with a good
expression in point of good sense and good-humour. Her
conversation, so far as I have had the advantage of hearing it, is
shrewd and sensible, but noways brilliant. She dined with us, went
off as if to the play, and returned in the character of an old Scottish
lady. Her dress and behaviour were admirable, and her conversation
unique. I was in the secret, of course, and did my best to keep up the
ball; but she cut me out of all feather. The prosing account which she
gave of her son, the antiquary, who found an auld wig in a slate-
quarry, was extremely ludicrous; and she puzzled the Professor of
Agriculture with a merciless account of the succession of crops in the
parks around her old mansion-house. No person to whom the secret
was not entrusted had the least guess of an imposture, except one
shrewd young lady present, who observed the hand narrowly, and
saw that it was plumper than the age of the lady seemed to warrant.”
From a note appended to this entry by Mr. Douglas we learn what Sir
Walter said to Miss Stirling Graham on this occasion, by way of
complimenting her on her performance after it was over. “Awa’,
awa’!” he said; “the Deil’s ower grit wi’ you.” There was, he saw,
something supernatural in her when she was in the mood and
attitude of her one most congenial function. All the gifts that were
latent in the shrewd and sensible-looking, but noways brilliant lady,
flashed out upon others, and were revealed even to herself, in the act
of her personations.
With the lesson in our minds which this little story supplies, we
may return to the matter of Scott’s reputed deficiency in the
speculative or purely noetic faculty:—Noetic faculty! Noetic
fiddlestick! This faculty, with a score of others perhaps for which our
meagre science of mind has no names, you will find in Scott too, if
you know how to look for them. When and where would you have
looked for the noetic faculty in Nelson? Not, certainly, as he was to
be seen in common life, a little man of slouching gait, with his empty
right arm-sleeve pinned to his breast, and gravely propounding as an
unanswerable argument in his own experience for the immateriality
of the soul the fact that, though there was now an interval of half a
yard from the stump of his lost arm and the place where his fingers
had been, he could still sometimes feel twitches of rheumatism in
those merely spectral finger-tips. No! but see him on his own great
wooden three-decker, as he was taking her into action between the
enemy’s lines, when the battle-roar and the battle-flashes had
brought the electric shiver through his veins, and he stood among his
sailors transmuted into the real Nelson, seamanship incarnate and a
fighting demigod! So, with the necessary difference for the purpose
now in view, in the case of Scott. His various faculties of intellect
were involved inextricably somehow in that imaginative faculty
which he did possess, and also in enormous degree, in common with
Shakespeare. When Scott was engaged on any of his greater works,—
a Lay of the Last Minstrel, a Marmion, a Lady of the Lake, a
Waverley, a Guy Mannering, an Antiquary, an Old Mortality, a
Heart of Midlothian, an Ivanhoe, or a Redgauntlet,—when he was so
engaged, and when the poetic phrenzy had seized him strongly,—
then what happened? Why, then that imaginative faculty which
seemed to be the whole of him, or the best of him, revealed itself
somehow as not a single faculty, but a complex composition of
various faculties, some of them usually dormant. This it did by
visibly splitting itself, resolving itself, into the multiplicity of which it
was composed; and then the plain everyday man of the tall upright
head, sagacious face, and shaggy eyebrows, was transmuted, even to
his own surprise, into a wizard that could range and speculate,—
range and speculate incalculably. It was, I say, as if then there were
loosened within him, out of his one supposed faculty of phantasy, a
simultaneous leash of other faculties, a noetic faculty included, that
could spring to incredible distances from his ordinary self, each
pursuing its appropriate prey, finding it, seizing it, sporting with it,
and coiling it back obediently to the master’s feet. In some such way,
I think, must be explained the splendour of the actual achievements
of Scott’s genius, the moderate dimensions of his purely reasoning
energy in all ordinary circumstances notwithstanding. His reasoning
energy was locked up organically, let us say, in his marvellous
imagination. And so, remembering all that Scott has left us,—those
imperishable tales and romances which no subsequent successes in
the British literature of fiction have superseded, and by the glamour
of which his own little land of brown heath and shaggy wood,
formerly of small account in the world, has become a dream and
fascination for all the leisurely of all the nations,—need we cease,
after all, from thinking of him in juxtaposition, due interval allowed,
with England’s greatest man, the whole world’s greatest man, of the
literary order, or abandon the habit of speaking of Sir Walter Scott as
our Scottish Shakespeare?
CARLYLE’S EDINBURGH LIFE[9]
PART I.—1809–1818
Early in November 1809 two boys walked together from
Ecclefechan in Dumfriesshire to Edinburgh, to attend the classes in
the University there. The distance, as the crow flies, is about sixty
miles; and the boys took three days to it. The elder, who had been at
College in the previous session, and therefore acted as the guide,
generally stalked on a few paces ahead, whistling an Irish tune to
himself. The younger, who was not quite fourteen years of age, and
had never been out of Dumfriesshire before, followed rather wearily,
irritated by the eternal Irish tune in front of him, but mainly given up
to his own “bits of reflections in the silence of the moors and hills.”
The elder of the two boys was a Thomas Smail, afterwards of some
note as a Burgher minister in Galloway; the younger was Thomas
Carlyle.
Of the arrival of the two boys in Edinburgh on the 9th of
November 1809, after their third day’s walk of twenty miles, and of
Carlyle’s first stroll, that afternoon, under Smail’s convoy, through
some of the main streets, to see the sights, one may read in his own
Reminiscences. What he remembered best of that first stroll was the
look of the Old High Street, with St. Giles’s Kirk on one side and the
old Luckenbooths running up the middle in its broadest part, but
chiefly the amazing spectacle to which he was introduced when Smail
pushed open a door behind St. Giles’s Kirk, and he found himself in
the outer house of the Court of Session, amid the buzz of the lawyers
and others walking up and down, with the red-robed judges hearing
cases in their little throned enclosures.
Content with the description of that first stroll, he leaves us to
imagine how, in the first days and weeks of his residence in the city,
he gradually extended his acquaintance with it by further rambles,
and by inspection of this and that interesting to a young stranger.
The task is not difficult. The lodging which Smail and he had taken
between them was, he says, “a clean-looking, most cheap lodging,” in
the “poor locality” called Simon Square. The locality still survives
under that name, though hardly as a square any longer, but only a
poor street, at the back of Nicolson Street, on the left hand as one
goes southwards from the University, and accessible most directly by
an arched passage called Gibb’s Entry. From that obscure centre, by
walks from it in the mornings, and returns to it during the day and in
the evenings, we can see the little Dumfriesshire fellow gradually
conquering for himself some notion of the whole of that Edinburgh
into which he had come. It was the old Edinburgh, of less than
100,000 inhabitants, which we think of so fondly now as the
Edinburgh of Scott before his novels had been heard of and when his
fame depended chiefly on his poems, of Jeffrey in the early heyday of
his lawyership and editorship of the Edinburgh Review, and of the
other local celebrities, Whig and Tory, immortalised in tradition and
in Cockburn’s Memorials.
It was chiefly of the externals of the city that the boy was making
his notes; for the living celebrities, as he tells us, were hardly even
names to him then. Scott and Jeffrey, he says, may have been in the
peripatetic crowd of wigged and gowned lawyers he had seen in the
hall of the Parliament House on the day of his arrival; but the only
physiognomy he had marked there so as to know it again was that of
John Clerk of Eldin. A reminiscence which I have heard from his own
lips enables me, however, to connect his first days in Edinburgh with
the memory of at least one Edinburgh worthy of a still elder
generation. It was on the 18th of December 1809, or just six weeks
after Carlyle’s arrival in Edinburgh, that the well-known Dr. Adam,
Rector of the High School, died; and I have heard Carlyle tell how the
event impressed him, and how he went to see the funeral procession
of the old scholar start from the High School yard at the foot of
Infirmary Street. With a number of other boys, he said, he hung on
by the railings outside, looking in upon the gathered assemblage of
mourners. He seemed to remember the scene with peculiar
vividness; for, after picturing himself as a boy hanging on by the
High School railings, and watching the incidents within, he added,
“Ay me! that moment then, and this now, and nothing but the
rushing of Time’s wings between!”[10] He had a liking to the last for
old Dr. Adam. I have heard him say that any Scotsman who was at a
loss on the subject of shall and will would find the whole doctrine in
a nutshell in two or three lucid sentences of Dr. Adam’s Latin
Grammar; and I had an idea at the time that he had used this brief
precept of Dr. Adam’s little book in his own early practice of English.
At the date of Dr. Adam’s death Carlyle had been for six weeks a
student in the University, with pupils of Dr. Adam among his fellow-
students on the same benches. One can see his matriculation
signature, “Thomas Carlyle,” in his own hand,—a clear and good
boyish hand, differing considerably from that which he afterwards
wrote,—in the alphabetically arranged matriculation list of the Arts
Students of the session 1809–10. It is the sixth signature under the
letter C, the immediately preceding signature being that of a
Dumfries youth named “Irvine Carlyle” (spelt so, and not “Irving
Carlyle,”) of whom there is mention in the Reminiscences. It is clear
that the two Carlyles were drawn to each other by community of
name and county, if not by kin, and had gone up for matriculation
together.
The College of those days was not the present complete
quadrangle, but a chaotic jumble of inconvenient old class-rooms,
with only parts of the present building risen among them, and
finished and occupied. The classes which Carlyle attended in his first
session were the 1st Humanity Class, under Professor Alexander
Christison, and the 1st Greek Class, under Professor George Dunbar.
From an examination of the records I find that among his class-
fellows in both classes were the aforesaid Irving Carlyle, and Lord
Inverurie, afterwards seventh Earl of Kintore, and that among his
class-fellows in the 1st Greek Class was the late venerable Earl of
Wemyss, then Lord Elcho. Neither from the records nor from the
Reminiscences can anything be gathered of the history of the two
classes through the session, or of the place taken in each by the
young Dumfriesshire boy among the medley of his fellow-students,
from 150 to 200 in number. The Latin class-room, we do learn from
the Reminiscences, was a very dark room, so that Professor
Christison, having two students of the name of Carlyle, never
succeeded in distinguishing the one from the other; which was all the
harder, Carlyle thought, because the other Carlyle, Mr. Irving
Carlyle, was not only different physically, being “an older,
considerably bigger boy, with red hair, wild buck teeth, and scorched
complexion,” but was also the worst Latinist in the whole class.
Carlyle himself had been so well grounded in Latin at Annan School
that probably he could have held his own in the class even against
Dr. Adam’s pupils from the Edinburgh High School. To the end of his
life, at all events, he was a fair Latinist. To Greek he never in later life
made any pretence; and whatever Greek he did learn from Dunbar,—
which can have been but small in quantity,—must have faded
through disuse. He retained, however, a high admiration for the
Elementa Linguæ Græcæ of Dr. James Moor of Glasgow,—which
was, I suppose, the Greek grammar then used in Dunbar’s class,—
thinking it the very best grammar of any language for teaching
purposes he had ever seen.
While we know so little of Carlyle’s Greek and Latin studies in
his first University session, it is something to know that he was a
pretty diligent reader of books that session from the College Library.
Having examined a dusty old folio of the library receipts and
outgoings, which chances to have been preserved, I am able to report
that Carlyle had duly paid, before December 1809, his deposit or
security of one guinea, entitling him to take books out, and that, in
that month and the succeeding month of January 1810, he had out
the following books, in parcels or in succession, in the following
order:—Robertson’s History of Scotland, vol. ii.; Cook’s Voyages;
Byron’s Narrative, i.e. “the Hon. John Byron’s Narrative of the Great
Distresses suffered by Himself and his Companions on the Coast of
Patagonia, 1740–6”; the first volume of Gibbon; two volumes of
Shakespeare; a volume of the Arabian Nights; Congreve’s Works;
another volume of the Arabian Nights; two volumes of Hume’s
England; Gil Blas; a third volume of Shakespeare; and a volume of
the Spectator. This is a sufficiently remarkable series of volumes for
a boy of fourteen to have had out from the College library; and other
books from other libraries may have been lying at the same time on
the table in the small room in Simon Square which he shared with
Tom Smail. What is most remarkable is the run upon books of
voyages and travels, and on classic books of English literature, or
books of mere literary amusement, rather than on academic books.
Clearly there had been a great deal of previous and very
miscellaneous reading at Ecclefechan and Annan, with the already
formed result of a passion for reading, and very decided notions and
tastes as to the kinds of books that might be worth looking after. But
how, whether at Ecclefechan or in Annan, had the sedate boy been
attracted to Congreve?
At the close of Carlyle’s first college session in April 1810 he
returned to Ecclefechan. He was met on the road near the village, as
he tells us so touchingly in his Reminiscences, by his father, who had
walked out, “with a red plaid about him,” on the chance of seeing
Tom coming; and the whole of the vacation was spent by him at
home in his father’s house. It is not, therefore, till the beginning of
the session of 1810–11 that we again hear of him in Edinburgh. He
then duly matriculated for his second session, his signature again
standing in the alphabetical Arts matriculation-list immediately after
that of his namesake “Irving Carlyle” (now spelt so). His classes for
this session were the 1st Mathematical Class, under Professor John
Leslie, and the Logic Class, under Professor David Ritchie; and I
have found no note of his having gone back that year, or any other,
for a second course of Latin from Professor Christison. In the 1st
Mathematical Class, consisting of seventy students, he had again
Irving Carlyle on the benches with him; in the Logic Class, consisting
of 194 students, the same Irving Carlyle was one of his fellow-
students, and the late Earl of Wemyss was another. What he made of
the Logic Class we have not the least intimation; and it is only by
inference that we know that he must have distinguished himself in
the Mathematical Class and given evidences there of his unusual
mathematical ability. As before, however, he found variation, or
diversion, from his work for the classes by diligent reading in his
lodgings. Between Saturday the 1st December 1810 and Saturday 9th
March 1811, I find, he took from the University library the following
books in the following order:—Voyages and Travels, the 15th volume
of some collection under that name; a volume of Fielding’s works; a
volume of Smollett; Reid’s Inquiry into the Human Mind; a book
called Scotland Described; two more volumes of Fielding’s works;
Locke’s Essay in folio; another volume of Fielding; a volume of
Anacharsis, i.e., of an English Translation of the Abbé Barthélémy’s
Travels of Anacharsis the Younger in Greece during the middle of the
Fourth Century before the Christian Era; and a volume of some
translation of Don Quixote. His choice of books, it will be seen, is still
very independent. Reid’s Inquiry and Locke’s Essay connect
themselves with the work in the Logic Class; but the other volumes
were evidently for mere amusement. Whether it was still in the
lodging in Simon Square, and with Smail for his chum, that these
books were read, is uncertain. His comradeship with Smail
continued, indeed, he tells us, over two sessions; but the lodging may
have been changed. It was still, doubtless, somewhere near the
University.
For the session of 1811–12 the Matriculation Book is not
alphabetically in Faculties, but general or mixed for the three
Faculties of Arts, Law, and Medicine. There were 1475 students for
those three Faculties conjointly; and “Thomas Carlyle, Ecclefechan,”
appears among them, his matriculation number being 966. That
session, his third at the University, he attended the 2d Greek Class,
under Dunbar, the 2d Mathematical Class, under Leslie, and the
Moral Philosophy Class, under Dr. Thomas Brown. In the Greek
Class, which consisted of 189 students, he had among his class-
fellows the late venerable Sir Robert Christison, Sir Robert’s twin-
brother, Alexander Christison, the late Earl of Wemyss again, his
brother, the Honourable Walter Charteris, a Thomas Murray from
Kirkcudbrightshire, afterwards a well-known citizen of Edinburgh,
the inextinguishable Irving Carlyle, and an Andrew Combe, whom I
identify with the subsequently well-known Dr. Andrew Combe, the
brother of George Combe the phrenologist. In the Mathematical
Class, which numbered forty-six, there were several Dumfriesshire
students besides himself; and it was in this 2d Mathematical Class, if
the tradition is correct, that Carlyle took the first prize,—another
Dumfriesshire youth, who lived in the same lodging with him, taking
the second. I have turned with most interest, in this session, to the
“List of Students attending Dr. Thomas Brown’s Class,” preserved in
the peculiarly neat, small handwriting of Dr. Brown himself. It was
the second session of Brown’s full tenure of the Professorship of
Moral Philosophy in succession to Dugald Stewart, and the fame of
his lectures was at its highest. The class consisted of 151 students;
and among them, besides Carlyle and his inseparable Irving Carlyle,
and a Robert Mitchell and a Paulus Aemilius Irving, both from
Dumfriesshire, there were Duncan McNeill, afterwards Lord
Colonsay, his brother, John McNeill, Sir Andrew Agnew, David
Welsh, afterwards Dr. David Welsh and Professor of Church History,
and a James Bisset from Aberdeenshire, whom I identify with the
late Rev. Dr. Bisset of Bourtie. Some of these were outsiders, already
in the Divinity or Law Classes, who had returned to the Moral
Philosophy Class for the benefit of Dr. Brown’s brilliant lectures,—
notably young David Welsh, who had already attended the class for
two sessions, but was full of enthusiasm for Brown, whose
biographer and editor he was to be in time. Carlyle, I am sorry to say,
was not one of the admirers of the brilliant Brown. Over and over
again I have heard him speak of Brown, and always with mimicry
and contempt, as “a finical man they called Brown, or sometimes
Missy Brown, that used to spout poetry.” This can hardly have been
out of disregard for metaphysics as such, for he had much respect for
Dugald Stewart, the then retired professor. The dislike seems to have
been partly personal, partly to the new kind of highly ingenious
metaphysics which Brown was trying to substitute for the older and
more orthodox Scottish Philosophy of Reid and Stewart. At all
events, it is worthy of note that those brilliant lectures of Thomas
Brown, which James Mill and John Stuart Mill admired so much in
their published form, regarding them as an introduction to much
that is best in modern British Philosophy, had no effect, in their
actual delivery, on the hard-headed young Carlyle, but fell upon him
as mere dazzle and moonshine.
As Carlyle tells us incidentally that he was in Edinburgh in the
summer of 1812, it is to be supposed that he spent less of that
vacation than usual in his Dumfriesshire home. I find also that he
matriculated rather late in our books for the session of 1812–13, his
name not appearing in the first or main matriculation list, but only in
a supplementary list, and then as “Thomas Carlyle, Hoddam,
Dumfriesshire.” His father had by that time given up his trade of
mason, and had left Ecclefechan to try a small farm in the
neighbourhood. The number of students matriculated that year in
the three faculties of Arts, Law, and Medicine, was 1503; and
Carlyle’s matriculation number was 1403. The classes in which he
was enrolled for that session, his fourth and last in Arts, were Leslie’s
2d Mathematical Class (attended a second time, we may suppose, for
such higher instruction as might be fit for very advanced students),
and the Natural Philosophy Class, under Professor John Playfair. In
this last session, accordingly, as a student only of Mathematics and
Physics, with no distraction towards either Classics or Mental
Philosophy, Carlyle may be said to have been in his element. He
worked very hard in both classes, and distinguished himself in both.
My own impression, from talks with him on the subject, is that he
was, by acknowledgment of professors and fellow-students, easily
supreme in both. Leslie’s second class that year numbered but forty-
one students, and it was natural that his most distinguished student
in two previous sessions should now be familiar with him and receive
his especial notice. Certain it is that of all the Professors of
Edinburgh University in Carlyle’s time Leslie was the only one of
whom he spoke always with something of real gratitude and
affection. The affection was mixed, indeed, with a kind of laughing
remembrance of Leslie’s odd, corpulent figure, and odd rough ways;
and he would describe with particular gusto the occasional effects of
Leslie’s persistent habit of using hair-dyes, as when a streak of pink
or green would be observable amid the dark-brown or black on those
less accessible parts of his head where the chemicals had been too
liberally or too rashly applied. But he had a real esteem for Leslie’s
great abilities, and remembered him as a man to whose
mathematical instructions, and to whose private kindness, he owed
much.——A greater Hero with him in Pure Mathematics than even
Leslie, I may mention parenthetically, was the now totally-forgotten
John West, who had been assistant-teacher of Mathematics in the
University of St. Andrews for some time from about 1780 onwards,
and of whom Leslie, Ivory, and all the other ablest mathematicians
sent forth from that University, had been pupils. Of this man, whom
he knew of only by tradition, but whom he regarded as, after Robert
Simson of Glasgow, the most original geometrical genius there had
been in Scotland, I have heard him talk I know not how often. He
would sketch West’s life, from the time of his hard and little-
appreciated labours at St. Andrews to his death in the West Indies,
whither he had emigrated in despair for some chaplaincy or the like;
he would avow his belief that Leslie had derived some of his best
ideas from that poor man; and he expressed pleasure at finding I
knew something of West independently, and had a copy of West’s
rare Elements of Mathematics, published in 1784. That book,
obsolete now, was, I have no doubt, a manual with Carlyle while he
was studying Mathematics in Edinburgh University, as I chance to
know it had been with Dr. Chalmers at St. Andrews in his earlier
mathematical days.——Of Leslie’s colleague, the celebrated Playfair,
formerly in the Mathematical Chair, but since 1805 in that of Natural
Philosophy, Carlyle had a less affectionate recollection personally
than of Leslie. Sharing, I believe, the common opinion of Playfair’s
great merits, and minutely acquainted with the facts of his life, as
indeed he was with the biographies of all persons of any mark with
whom he had come into contact, he rather resented a piece of
injustice which he thought Playfair had done to himself. There were
131 students in the Natural Philosophy Class in 1812–13; and Carlyle,
as he assured me, was single in that whole number for having
performed and given in every one of all the prescribed exercises,
mathematical or other. Another Dumfriesshire student, who came
next to him, had failed in one, and that the most difficult. Naturally,
at the end of the session, he expected that his certificate would
correspond to his distinction in the class; and it was of some
consequence to him that it should. But, when he called at Playfair’s
house for the certificate, and it was delivered to him by a man-
servant, he was a good deal disappointed. The usual form of the
wording for a good student was to the effect that the Professor
certified that so-and-so had attended the class in such and such a
session and had “made good proficiency in his studies.” In Carlyle’s
case there was a certain deviation from this form, but only to the
effect that he had attended the class and that the Professor “had
reason to know that he had made good proficiency in his studies.” I
can remember Carlyle’s laugh as he told me of this delicate
distinction; and I have always treasured the anecdote as a lesson for
professors. They ought to be very careful not only in noting talent on
the benches before them, but also in signifying what they have
noted, if only because, as in Playfair’s case, they may be sometimes
entertaining an angel unawares, and some angels have severe
memories.
We have thus brought Carlyle to the summer of 1813, when he
had completed his Arts course in the University of Edinburgh, and
was in the eighteenth year of his age. Though qualified, according to
the present standard, for the degree of M.A., he did not take it; but in
that he was not in the least singular. In those days hardly any
Edinburgh student ever thought of taking a degree in Arts; as far as
Edinburgh University was concerned, the M.A. degree had fallen into
almost complete disuse; and not till within very recent memory has it

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CHAPTER 14 Promotion of Safety 361

CHAPTER 15 Infection Control 386

CHAPTER 16 Vital Signs 446

CHAPTER 17 First Aid 478

CHAPTER 18 Preparing for the World of Work 544

Part 2 Special Health Care Skills 564

CHAPTER 20 Laboratory Assistant Skills 651

CHAPTER 21 Medical Assistant Skills 710

CHAPTER 22 Nurse Assistant Skills 763

CHAPTER 23 Physical Therapy Skills 896

CHAPTER 24 Business and Accounting Skills 931

Appendix A: Career and Technical Student Glossary984

Organization of Text to moving on to another information section.

a student in health science education, it is impor- Safety—Proceed with Caution

tant to check the specific regulations for your

cedure without checking legal responsibilities. In addition, for Nurse Assistants

authorized to perform it. Legal Responsibility

• The text material covers the National Health Care Career

Foundation Standards. Health Insurance Portability

• Mandates of the Health Insurance Portability and and ­Accountability Act

responsibilities in regard to this act.

Extensive Teaching performance-based assignment and evaluation sheets.

Additional Student Resources Activity Manual to Accompany Health Care Career

Icons are used throughout the text to high- oral temperature

• Measure and record axillary temperature accurately. bradypnea (brad 0-ip-nee9-ah)

for Nurse Assistant

key is presented at the beginning of each

Legal Responsibility Electronic Health Records

• Measure and record blood pressure to an accuracy within 62 mm of actual reading.

Related Health Careers

related health Careers

Information Sections 11:1 Fundamentals of Nutrition

5. Hold the plate firmly in one hand (Figure 20–11A) or place

09511_ch20_hr_651-709.indd 664 13/08/15 3:47 pm

Full-Color Photos and Illustrations

09511_ch09_hr_262-278.indd 277 6/22/15 3:28 PM

Review Questions review QuesTiOns

the chapter again. CONFHER model and Rosenbaum.

Thalea J. Longhurst Karen Ruble Smith, RN, BSN

Dynarex Omron Healthcare

That Scott was an exception,—that he was, like Shakespeare, one of

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Appendix A: Career and Technical Student Glossary984

Foundation Standards. Health Insurance Portability

• Mandates of the Health Insurance Portability and and Accountability Act