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Introduction to Health Care, Fifth Edition © 2021, 2017, 2012 Cengage Learning, Inc.
Lee Haroun and Dakota Mitchell
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iv | Contents
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Contents | v
Digestive 164
CHAPTER 10
Urinary 166
Infection Control 217
Systems for Sensing, Coordinating, and Controlling 168
Importance of Infection Control in Health Care 218
Eyes and Ears 168
Scope of the Problem 218
Nervous 172
Endocrine 177 Regulatory Agencies 219
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Contents | vii
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viii | Contents
CHAPTER 21 CHAPTER 23
Emergency Procedures 441 Quality Control and Customer Service 497
Emergency Situations 442 Quality of Care 498
When an Emergency Occurs 443 Approaches to Measuring Quality of Care 498
Cardiopulmonary Resuscitation (CPR) 444 Quality Improvement 499
First Aid Procedures 444 Centers for Medicare and Medicaid Services 499
Allergic Reactions 445 The Joint Commission 499
Bleeding and Wounds 447 Agency for Healthcare Research and Quality 500
Bone, Joint, and Muscle Injuries 447 American Hospital Association 500
Injuries to Facial Structures 452 Internal Monitoring 500
Burns 452 Reducing Medical Errors 501
Drug Abuse 461 Medication Errors 502
Poisoning 461 Customer Service 502
Temperature-Related Illness 462 Taking Responsibility for Quality 504
Other Conditions 466 Customer Satisfaction 505
Bandaging 466 Internal Customers 505
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Contents | ix
CHAPTER 25 APPENDIX 1
Interview, Portfolio, and Application 531 Health Care Professional Organizations 565
The Job Interview 532 Therapeutic and Treating Occupations 565
The Importance of Proper Preparation 532 Dental Occupations 565
Learn About the Employer 532 Emergency Medical Occupations 565
Prepare to Demonstrate Your Qualifications 532 Home-Care and Long-Term Care
Prepare Your Questions 533 Occupations 565
Questions to Avoid 533 Massage Therapy Occupations 565
Anticipating an Employer’s Questions 533 Medical Office Occupations 565
Creating a Professional Appearance 535 Mental Health Occupations 566
Securing References 536 Nursing Occupations 566
Creating a Portfolio 537 Occupational Therapy Occupations 566
What to Take to an Interview 537 Pharmacy Occupations 566
Practice, Practice, Practice 538 Physical Therapy Occupations 566
Starting Off on the Right Foot 538 Respiratory Therapy Occupations 567
Recent Trends in Interviews 539 Surgical Occupations 567
After the Interview 539 Veterinary Occupations 567
Additional Requirements 540 Vision Care Occupations 567
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x | Contents
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Preface
Introduction to Health Care, time, today’s graduates face new challenges. Changes
Fifth Edition, is designed as an in health care are rapid and continuous. Professionals
introductory text for students at all levels are being given additional responsibilities.
who are entering college- Efficiency and flexibility, combined with competency,
level health care programs are vital to workplace success. To be competent and suc-
or for those who believe they cessful in this ever-changing environment, health care
may be interested in pursuing a career in health care. The professionals must be able to think for themselves and
fundamentals common to all health care professions are pre- learn and adapt as necessary to meet current employ-
sented in this full-color text to create a foundation on which ment demands.
students can build when they take their specific professional The authors recognize the need of health care educa-
courses. The topics included are appropriate for professions tors for materials that can assist them in preparing stu-
that involve direct patient care, such as nursing and dental dents to assess new situations, determine appropriate
assisting, as well as those that provide support services, such action, and apply on the job what they learned in the
as health information technology and pharmacy technician. classroom. This text is designed to help meet this need.
The goal of the text is to present a broad base of health care Students are introduced to the concept of thinking like
essentials. Therefore, skills and procedures that apply only to a health care professional (also called “critical thinking”)
specific professions are not included. in Chapter 1. The specific skills that make up applied
The text is written in easy-to-understand language. A thinking are explained in everyday language. A five-
variety of learning exercises are included in each chapter. step problem-solving model is clearly described to help
These exercises are designed to appeal to the different students systematically approach new situations. Every
ways that students comprehend and learn material. The chapter includes exercises called “Thinking It Through”
text can be used by students as a reference book after that require students to apply the concepts presented
completion of their introductory courses. in the text to typical on-the-job situations. Each chapter
then concludes with two application exercises and one
CONTENT FOR TODAY’S HEALTH CARE PROFESSIONAL problem-solving exercise that provide opportunities to
Introduction to Health Care, Fifth Edition, includes topics summarize and apply the chapter content. For a detailed
essential for today’s student and tomorrow’s health care review of the features in this book, see About This Book
professional. The basic concepts that create the foundation on page xix.
for health care education have been expanded beyond
those usually included in an introductory text. The follow- ORGANIZATION OF THE TEXT
ing topics have been included in response to the current
Introduction to Health Care, Fifth Edition, is divided into
needs of health care educators and employers:
nine units that contain between two and five chapters of
• Thinking skills related topics. The following overview highlights many of
• Study techniques the major concepts included in the text.
• Complementary and alternative medicine
Unit 1 | Health Care Today
• Prevention and wellness strategies
• Characteristics and trends of modern health care,
• Lifelong learning and continuing education
including changing patient demographics, chal-
• Documentation lenges in health care today, and complementary and
• Cost-control measures alternative medicine
• Performance improvement • Descriptions of many health occupations, organized
• Personal efficiency by type of work performed
• Customer service • Explanation of how to think like a health care
professional
EMPHASIS ON THINKING SKILLS • Personal characteristics required of health care
The dramatic growth of the health care industry promises professionals
to provide increasing numbers of employment opportu- • Legal and ethical responsibilities of health care
nities for graduates of health care programs. At the same professionals
xi
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xii | Preface
Unit 2 | The Language of Health Care Unit 6 | Communication in the Health Care Setting
• Introduction to basic concepts of medical terminology • Patients as individuals
• Examples of common word elements • Basic human needs
• Suggested ways to approach the study of terminol- • Acknowledging diversity while avoiding cultural
ogy and to learn it systematically stereotypes
• Review of math skills necessary for health care • The six-step communication process
applications • Using questions and observations to assess specific
• Measurement systems and methods of converting patient needs
between systems • Basic oral and written communication techniques
• Calculating drug dosages • Overview of computer applications in health care
• Tips for dealing with math anxiety • Basics of health care documentation and medical
records
Unit 3 | The Human Body
• Brief overview of the basic organization, structure,
Unit 7 | Health Care Skills
and functions of the body systems, intended as an • Basic assessment skills
introduction rather than a complete anatomy and • Hands-on skills, such as taking vital signs and mea-
physiology course suring height and weight
• Examples of diseases and conditions related to each • Normal ranges and significant changes
body system
• Step-by-step instructions for performing basic emer-
• Preventive measures for each system, including life- gency procedures (Cardiopulmonary resuscitation is
style management tips not included because certification is often required
• Physical and mental milestones of growth and devel- of health care students and the course is taught by
opment over the life span and the implications when certified instructors who use annually updated, writ-
providing health care ten materials instead of a textbook.)
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Preface | xiii
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xiv | Preface
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Preface | xv
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xvi | Preface
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Preface | xvii
Procedures
10–1 Handwashing These procedures show step-by-step directions and 227–228
10–2 Nonsterile Gloves rationales with accompanying figures to illustrate the steps. 230–231
10–3 Applying and Removing PPE 232–235
10–4 Sterile Gloves 237–239
The Challenges The most common contagions that health care professionals 245–253
may encounter, including drug resistant organisms
Reporting Accidental Exposure OSHA regulations that apply to all health care facilities 253
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Dedication
In memory of David, who continues to inspire.
—Lee Haroun
To the future health care professionals who will dedicate their time and energy to taking care
of those in need of their services. May your career be as rewarding to you as mine is to me.
—Dakota Mitchell
Acknowledgments
The authors wish to acknowledge the help, support, Mischelle Monagle, MSN, MBA, RN
and continual good humor of Laura Stewart, Managing Dean of College of Nursing & Health Professions
Editor, Deb Myette-Flis, Senior Product Manager, and Carl Sandburg College Galesburg, Illinois
Ken McGrath, Senior Content Manager, at Cengage Shirley J. Cherry, Ed.D., R.T. (R)
Learning who patiently shepherded us through the Associate Professor and Program Director
process of producing a fifth edition. A special thank Radiologic Science East Tennessee State University
you to all the reviewers who offered many wonderful Johnson City, TN
suggestions.
S. Summers
Dr. Susan Grant Adjunct Professor
Assistant Professor Johnson County Community College Overland Park,
Harper College- Health Science Palatine, IL Kansas
xviii
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About This Book
Objectives: Overview of chapter con-
Unit
tent and goals for learning. Review 1 Health Care Today
these before beginning to read the CHAPTER 1
chapter and use the objectives to Your Career in Health Care
check your progress after completing KEY TERMS
assessment
OBJECTIVES
Studying and applying the material in this chapter will help you to:
the chapter.
biases
1. Describe the current economic status of the health care industry.
career ladders
2. Describe the general employment projections for the health care industry.
certification
3. List the ten health care jobs expected to have the largest percentage
diagnostic
increases between 2016 and 2026, according to the U.S. Department of
integrity Labor Statistics.
licensure 4. List the six health care jobs expected to have the highest numbers of
manual dexterity openings between 2016 and 2026, according to the U.S. Department
objective data of Labor Statistics.
presented in the chapter. Key terms are bolded and defined the first symptoms
therapeutic
10. Give examples of suggestions to improve your note-taking, reading,
writing, and test-taking skills.
11. Describe the advantages and challenges that may be experienced by
adult students who are returning to school.
time they appear in the chapter. There is also a comprehensive glos- 12. List the five techniques that adult students can use to develop their
personal organization and time management skills.
13. Explain the meaning of “thinking like a health care professional.”
tent and show why the material in the chapter is important for the
competent health care professional. An application exercise at the
end of the chapter refers back to the case.
Fascinating Facts
In 2016, there were 46 million persons aged 65 and over,
representing 15% of the total population. By 2060, this
number is projected to be 98 million persons, who will
make up 24% of the population. This increase will have
Fascinating Facts: Interesting information related to the chapter major implications for the health care industry, driving
the need for more professionals.
topics.
Source: https://www.prb.org/aging-unitedstates-fact-sheet/
Box 1–1
Boxes: These include special features and additional information that Examples of Health Care Occupations
expand on and support the material presented in the chapter. Art Therapist
Athletic Trainer
Audiologist
Health Educator
Medical Illustrator
Medical Librarian
Medical Photographer
Medical Writer
Music Therapist
Speech and Language Pathologist
xix
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xx | About This Book
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Unit
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2 | Chapter 1
overwhelmed by the number of choices in the health care field. He is not sure how to learn more about the requirements
and rewards of various occupations, what the daily duties would be, and how much education is necessary to enter
them. He is also unsure how to best go about making a decision that will significantly affect his life. This chapter includes
basic information about a variety of health care career areas and occupations, a problem-solving process that can be
used to make effective personal and professional decisions, and tips on succeeding in a health care career program.
YOUR FUTURE IN HEALTH CARE Table 1–1 Examples of Growing Health Care Jobs
Projected
Health care is an exciting and growing field. The purpose Percentage Increase
of this text is to help you make an informed career choice in Employment,
and acquire the basic knowledge to continue the studies Job 2016–2026
necessary for your chosen field. Home Health Aide 47%
The health care industry is the largest service employer
Personal Care Aide 39%
in the United States, providing more than 18 million jobs
and the need for health care professionals continues to Physician Assistant 37%
grow (https://www.cdc.gov/niosh/topics/healthcare/default
Nurse Practitioner 36%
.html). According to the United States Bureau of Labor
Statistics, the health care industry will increase by 18% and Physical Therapist Assistant 31%
add 2.4 million new jobs between 2016 and 2020 (https:// Physical Therapist Aide 29%
www.bls.gov/ooh/healthcare/home.htm). This is faster than
the average growth of all other occupations. Federal econo- Medical Assistant 29%
mists report that, in 2017, the amount spent on health care Occupational Therapy Assistant 29%
was $3.5 trillion. Further, it is projected that the cost of health
Physical Therapist 28%
care will continue to grow at least 4% annually.
Many health care occupations are projected to have Massage Therapist 26%
employment increases of more than 25%. (See Table 1–1.) Source: Bureau of Labor Statistics. Occupational Outlook Handbook. Fastest Growing
Ten of the 20 fastest-growing jobs in all industries are health Occupations. https://www.bls.gov/ooh/fastest-growing.htm
care–related. At the same time, 6 of the 20 occupations
with the largest numerical increases are in health care. Table 1–2 Occupations with the Largest Numerical Increases
(See Table 1–2.) It should be noted that various sources
Numerical Increase in
give different occupations as having the fastest growth Job Positions, 2016–2026
and highest numbers of new hires; however, health care is
Personal Care Aides 777,600
included in all lists. The information provided here is from
the U.S. Bureau of Labor Statistics. Registered Nurses 438,100
Careers in health care can be sources of great satisfac- Home Health Aides 431,200
tion. Health care professionals perform valuable services
that make a significant contribution to the community. Medical Assistants 183,900
Each day their work makes a difference in the quality of life Nursing Assistants 173,400
of those they serve. Whether you choose to work directly
Medical Secretaries 129,000
with patients or provide support services, be assured that
what you do is important and of benefit to others. Source: https://www.bls.gov/ooh/most-new-jobs.htm/
As well as providing satisfaction, health care work
makes many demands on those who pursue it. The work be noted and addressed before they become critical. The
must be taken seriously because it affects the well-being consequences of mistakes can be devastating if, for exam-
of others. All tasks must be performed thoughtfully and ple, a prescription for medication is incorrect or the wrong
conscientiously. Nothing can be taken for granted or done procedure is performed. The work can also be stressful.
automatically, not even routine assignments. Health care Depending on the chosen occupation, it can involve long
professionals must be willing to devote their full attention hours, dealing with the death of patients, and working
to everything they say and do. Potential problems must quickly under pressure. (See Figure 1–1.)
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Your Career in Health Care | 3
© kurhan/Shutterstock.com.
instructors and classmates. Be kind to everyone,
regardless of his or her background. Refrain from
talking during lectures. Prepare for classes so the
instructor does not need to take time to answer
questions about material covered in the reading or
study assignments. Practice courtesy in the class-
FIGURE 1–1 Successful health care professionals work hard. At room and throughout the school. Volunteer to help
the same time, they enjoy the satisfaction of helping others. others, as needed or as possible.
• Have integrity: Be honest at all times. Respect the
GETTING OFF TO A GOOD START privacy of others. Be loyal to the employer. Accept
responsibility for your actions.
Health care educational programs are designed to prepare
students to succeed in the workplace. Instructors dedicate °°Start now: Do your own work. Never copy the
themselves to helping students who put forth the neces- homework assignments of others or cheat on
sary effort to graduate and become employed. Take advan- exams. Always tell the truth. Never share anything
tage of the learning opportunities available in your school told to you in confidence.
and commit yourself to doing your best toward becoming • Be dependable: Be at work on time and as scheduled.
a competent, qualified health care professional. Follow through and finish all assigned tasks. Perform
work accurately and completely. Work without con-
Essential Core Qualities of Health stant supervision and reminders.
Care Professionals °°Start now: Be at school on time and attend all
As a student, you have many opportunities in school to classes. Complete assignments on time. Strive for
begin to practice good workplace habits. Work hard now to accuracy in all written and practical assignments.
develop the skills that will make you a valuable employee. Follow through on all obligations and anything you
At the same time, you can be acquiring habits that also have volunteered to do.
contribute to academic success. The qualities essential for • Work well with others: Strive to understand the feel-
health care professionals to be effective and successful can ings and needs of others. Be courteous and consider-
be applied in the classroom, in the lab, and at the clinical ate. Practice good communication skills. Be a good
(externship/internship/fieldwork) site. Start now while you team member by cooperating and contributing to
are in school to develop and apply them. the achievement of group goals. Take directions
• Care about others: Have compassion. Apply knowl- willingly from the supervisor.
edge and skills to decrease suffering and increase the
© Alexander Raths/Shutterstock.com.
Fascinating Facts
In 2016, there were 46 million persons aged 65 and over,
representing 15% of the total population. By 2060, this
number is projected to be 98 million persons, who will
make up 24% of the population. This increase will have
major implications for the health care industry, driving
the need for more professionals.
Source: https://www.prb.org/aging-unitedstates-fact-sheet/ FIGURE 1–2 One of the most important qualities of the health
care professional is compassion.
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4 | Chapter 1
°°Start now: Be understanding of the needs of • When working with patients, ask what might work
instructors and classmates. Participate in class. Do best for them and when it should be done.
your share when working on group assignments. • When sharing important information with a class-
• Be flexible: Be willing to adapt to changing condi- mate or coworker, ask yourself what you know about
tions and emergencies. Do what is needed to carry this person that will help you communicate most
out tasks. Acquire knowledge and skills necessary to effectively.
keep up with advances in technology and changes in • When working in a health care facility, consider how
the way health care is delivered. your work habits might be changed to improve over-
°°Start now: Accept instructional differences, all efficiency.
changes in class schedules, and other unexpected Some students believe that the role of their instructors
occurrences. Be willing to cooperate as needed. is to tell them rather than ask them. In reality, instructors
• Be willing to learn: Keep skills up to date. Ask ques- who continually ask questions that require students to
tions, attend workshops, read professional publica- explain their answers and actions are encouraging them
tions, use the Internet, and continue to acquire new to learn and to think like health care professionals. Some
skills. instructors even respond to a student’s question with
another question. Their intention is to teach students to
°°Start now: Be willing to learn: Take your studies begin to think for themselves and trust that they are capa-
seriously. Make school a high priority. Dedicate
ble of finding the answer. Instructors also use questioning
sufficient time to studying throughout the length
to guide students in pulling known facts together, mak-
of each course to ensure maximum learning.
ing connections, and applying what they know to new
situations. For example, suppose that a respiratory therapy
Learning for Mastery student is working with a hospitalized patient. He has stud-
Health care professionals must know what they are doing. ied the illness presented by the patient and knows how
Mistakes on the job can result in serious consequences. to perform the prescribed breathing treatments. Through
Therefore, it is essential that students commit to learning questioning, the instructor guides this student to explain
the material presented in their courses. Learning means why these particular treatments have been prescribed.
more than just memorizing facts. It means striving to The student is encouraged to consider the nature of the
understand and remember information so that it can be illness and the properties of the treatments and medica-
applied to new situations. This understanding provides a tions, and draw conclusions about the relationships among
basis for thinking like a health care professional, which is these factors.
discussed later in this chapter.
Students who do only the minimum necessary to pass Getting the Most from Your Studies
tests may think they are learning, but in reality, they are not If necessary, spend some time now working to improve
likely to have acquired the long-term knowledge neces- your study skills: taking notes, reading, writing, and prepar-
sary to perform on the job. Students who study to under- ing for tests. Something to keep in mind is that these skills
stand and always search out the why of the subject increase can also help you to get a job and succeed. For example,
their chances of becoming highly competent health care taking a patient history requires good note-taking skills;
professionals who can think on their feet and meet new understanding the instructions for a piece of equipment
challenges as they arise. requires the ability to read and understand technical mate-
One effective way for students to master subjects is to rial; preparing a letter asking about job openings requires
ask themselves questions about what they are learning or good writing skills; and if you think about it, everything you
doing. Questions serve to gather information, expand your do when working with a patient is a test, something you
view of a subject, and stimulate the mind. They help ensure must do correctly “to pass.”
that actions are not based on false assumptions or insuf- The following suggestions may help you to:
ficient information. • Take good notes: Concentrate on writing down the
Questions can be asked mentally (to oneself) or of important points, rather than everything the instruc-
others. Think of the five Ws plus the one H: What, When, tor says. Listen for clues from instructors about what
Where, Why, Who, and How. The following examples show is important. Write in outline form to keep notes
how questions can be used to promote learning: organized. Set up pages using the Cornell System
• When learning new information, ask why it is impor- format to leave space for adding notes and ques-
tant and to whom? How does it relate to what is tions after class when you review your notes. (See
already known? Figure 1–3.) For more detailed information about the
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Your Career in Health Care | 5
Volunteering
If you have the time, volunteering is an excellent way to
jump-start your career. Not only do you learn skills, such as
study notes column working with others, you learn more about the health care
notes field and acquire information that can help you choose a
and career that is right for you. Although work in a health care
questions environment is optimal, volunteering for non profits, such
to quiz as Habitat for Humanity, also provide good experience.
self Some educational programs have an admission
requirement that you have some experience in the field
you are entering. For example, university veterinary medi-
cine programs require applicants to have a minimum num-
summary ber of hours of experience. And when looking for a job, you
can list on your résumé the skills you learned and applied
through volunteering. This also shows potential employers
that you have initiative and a sincere interest in helping
others.
FIGURE 1–3 Page set-up for the Cornell note-taking
system.
Professional Organizations
Cornell system, see http://lsc.cornell.edu/notes.html Joining a professional organization while you are a student
and http://www.openculture.com/2018/10/the-cornell- gives you networking opportunities, a chance to learn how
note-taking-system.html. to be successful in your chosen field, and access to work-
• Read for comprehension and learning: When shops and other learning activities. And, as with volunteer-
reading textbooks or information on websites, ing, putting a professional membership on your résumé
start by skimming through the chapter or section. demonstrates your interest and initiative. See Chapter 14
Then focus your attention by creating questions and Appendix 1 for more information about professional
and reading for the answers. Create questions from organizations.
articles or section titles and from the material itself.
After reading a section of material, ask yourself the Returning Adult Students
questions and try to answer without looking at the
Many students who enroll in health care programs are
text. This has been shown to be one of the most
adults returning to school after working in other fields,
effective ways to learn. For more reading strategies,
raising families, and/or handling other adult responsibili-
see https://www.educationcorner.com/textbook-
ties. Some adults find the experience of attending classes
strategies.html and https://learningcenter.unc.edu
stressful and wonder if they have what it takes to study and
/tips-and-tools/reading-textbooks-effectively/.
learn new information and skills.
• Write: See Chapter 17 of this text. Also, Purdue These fears are natural, but the fact is that most adults
University’s online writing lab has information on have acquired life experiences and skills they can apply
dozens of topics related to writing: https://owl.purdue to their learning which, in many cases, will help them
.edu/owl/purdue_owl.html. become excellent students. For example, holding down
• Prepare for tests: Plan to study every day, even a job contributes to the ability to set priorities, communi-
for a short time. Reviewing material over time is cate, demonstrate dependability, and apply practical skills
much more effective than cramming at the last such as math. The self-confidence developed as a result of
minute. Use the questions you create for read- handling adult responsibilities can be applied to reviewing
ing and note-taking to practice. For more infor- one’s study skills, including those that may not have been
mation, see https://www.educationcorner.com/ used for many years.
test-taking-strategies.html. Quizlet at https://quizlet The most pressing problem for many adult students is
.com/ that contains learning tools and flashcards on finding the time to fulfill all their responsibilities: attending
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6 | Chapter 1
classes, studying, caring for the family, and perhaps hold- • Practicing good communication skills when gather-
ing down a full- or part-time job. Practicing good time ing and distributing information (see Chapters 16
management and personal organization skills, such as the and 17)
following, can be helpful in handling the additional work • Understanding exactly what one is legally allowed to
of attending school: do in one’s profession, known as scope of practice
• Start each day with a list of what needs to be accom- One of the major goals of this text is to provide stu-
plished, ranked from most to least important. dents with opportunities to practice thinking like a health
• Advise others of your study schedule. Plan care or care professional. This discussion on thinking is being pre-
activities for your children to allow you the time sented at the beginning of the text so that students will
needed. have maximum time to apply and practice thinking skills.
• Schedule time, even if for short periods, with fam- The “Thinking It Through,” “Application Exercises,” and
ily members. Some children enjoy doing homework “Problem-Solving Practice” features, which appear in every
with mom or dad. chapter, encourage students to apply thinking skills to the
topics presented.
• Create personal organization techniques, such as
Thinking proficiently can be applied to the personal, as
clustering errands, keeping things in repair, and plan-
well as professional, areas of your life. For example, buying
ning backups to prevent wasting time and energy.
a certain puppy simply because it is cute and seems the
• Ask for help when you need it. Delegate tasks at friendliest is an emotional decision. An informed, thinking
home. Let another family member fix dinner once or decision involves learning about available breeds, physical
twice a week. and personality characteristics, common health problems,
• See the Time Management section in Chapter 12 for and methods of training. Knowing these facts will help
more suggestions. ensure that the puppy selected best fits the new owner’s
lifestyle and will be a suitable companion.
Thinking like a health care professional can be
LEARNING TO THINK LIKE A HEALTH described as an “examined process.” This means not sim-
ply accepting situations without observing and consider-
CARE PROFESSIONAL ing the meaning of what is observed. Effective thinkers are
A common problem in health care today is that some grad- aware of their thoughts and of why and how they are act-
uates spend months, or even years, accumulating informa- ing or making decisions.
tion, but are unable to apply it when they need it on the As stated earlier, nothing in health care work can be
job. The lack of effective thinking skills is a primary reason done routinely and without thinking. Mindless actions
for this unfortunate situation. Regardless of the health care occur as the result of not paying attention or basing deci-
area or occupational level chosen by students, it is essential sions on ideas that have been accepted “just because.”
that they learn to think like health care professionals. This These ideas may come from family members, friends,
type of thinking actually involves many skills and, in this personal experiences, television, movies, and magazines.
text, has the following meanings: Health care professionals must learn to think for them-
• Learning for understanding, not simply to memorize selves, gather facts, and use their own observations for
facts making decisions.
• Applying learned material to new situations
• Having an organized approach to problem-solving Problem-Solving Process
• Basing decisions on facts, rather than on emo- Important applications of thinking skills are problem-
tional reactions or biases (certain beliefs and feel- solving and decision-making, two very important compe-
ings, usually negative, about a person because he tencies for health care professionals. There are a variety of
or she belongs to a specific group or has certain problem-solving and decision-making models. This book
characteristics) presents a five-step problem-solving process to help stu-
• Drawing on many facts and creating relationships dents and health care professionals approach problem-
among them solving in an organized manner:
• Locating reliable sources of information with which 1. Identify the problem
to make decisions 2. Gather information
• Basing decisions on ethical principles (see Chapter 3) 3. Create alternatives
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Your Career in Health Care | 7
5 2
Identify the
problem
The problem-solving
Evaluate and revise Gather
as needed
loop information
4 3
4. Choose an alternative and take action Jamie’s first reaction is, “I can’t help it. My car is old and
5. Evaluate and revise as needed breaks down a lot.” When her car won’t start, she must rely
on family and friends to drop her off at work. Their sched-
(See Figure 1–4.)
ules are not the same as Jamie’s, so she often arrives late.
Taking the time to think about what she has said
Step One—Identify the Problem (“I can’t help it”), Jamie realizes that being at work on time
Identifying problems is not always as simple as it sounds. is her responsibility. She is now able to identify the real
Factors that are described as the problem are often only problem: lack of reliable transportation. This enables her to
symptoms of the problem. For example, Jamie, a radiologic start seeking effective solutions. Accepting responsibility
technologist, does not receive the high scores she had for a problem makes it possible to start doing something
hoped for on her performance review at work. When she about it.
receives the rating “poor” in the dependability category,
she feels upset and believes that her problem is “receiving Step Two—Gather Information
a poor evaluation because her supervisor dislikes her.”
Good problem-solving is based on having accurate and
Identifying the real nature of problems requires a will-
reliable information. Acting on assumptions (untested
ingness to observe, pay attention, and confront difficult
ideas), opinions (beliefs not based on facts or knowledge),
issues. Problem-solvers must look beyond what seems
and emotions can result in poor decisions. In health care,
obvious and use questions effectively to identify the real
gathering information is also known as assessment. There
situation. Denying or ignoring problems does not make
are many methods for gathering information:
them go away. Problems that are not addressed tend to get
worse, because no action is being taken to resolve them. • Review what is already known: What knowledge do
In Jamie’s case, she must be willing to speak frankly with I have about the problem or situation? About the
her supervisor about her low rating. It turns out that the causes? About possible solutions?
real problem is actually what caused the poor evaluation, • Collect objective data: What can be observed?
not the evaluation itself. In Jamie’s case, it is her frequent Measured? Tested? What are the facts? When work-
tardiness. ing with patients, objective data are called signs.
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8 | Chapter 1
• Collect subjective data: How do I feel about a situ- one and consider the likely consequences, both positive
ation? What do I want? What do others want? When and negative.
working with patients, subjective data refer to what Based on her research, Jamie creates the following list:
is reported by the patient, such as pain and feeling 1. Take the bus to work. When the weather is nice, walk-
nauseated. Also known as symptoms, they cannot ing to the bus stop will be a good form of exercise. In
be directly observed or measured by the health care rainy weather, common about five months of the year
professional, but nevertheless must be taken into where she lives, getting to the bus stop without get-
account. ting soaked is not likely. Also, the bus ride takes about
• Conduct research: What are the facts? Are they from 30 minutes longer, each way, than driving to work.
a reliable (trustworthy) source? How do I know? Are
they scientifically based? (Can they be tested?)
• Ask for help: Who has useful knowledge? Are there
experts available who can give me reliable informa-
tion and help me find a solution? Thinking It Through
When she starts out, Jamie finds the idea of solving her Linda Stevens, LPN, works on a medical floor at the local
transportation problem overwhelming. The only solution hospital. One of the patients she has been assigned to
that makes sense to her is buying a new car, but she knows take care of is Frank Gibbons, a 72-year-old newly diag-
that most likely she cannot afford one at this time. When nosed with diabetes (a condition in which the body
she puts her fear aside and commits herself to gathering does not produce enough insulin to control blood
information, she discovers the following: sugar levels). Part of Linda’s process of preparing to
• Carpools have been organized at the facility where care for her patients is to review the patients’ charts for
she works. any new physician orders. She notes that Dr. Romero
• The most economical new car for sale in her area was in the previous evening and ordered the patient’s
costs $14,795. blood sugar to be checked at 8 a.m. According to the
results, insulin is to be given. (The higher the level of
• There are many articles on the Internet about how
blood sugar, the greater the amount of insulin that is
to buy a car.
given, based on a formula defined by the physician.)
• Consumer Reports magazine has a recent article Linda is a “thinking nurse” and starts to question if this
about purchasing used cars and publishes annual is an appropriate order. She realizes that breakfast trays
reports on the performance of most auto models arrive at 7:30 a.m. on her floor and that Mr. Gibbons will
manufactured over the past 10 years. already have eaten when she checks his insulin level
• Her credit union sponsors car sales to help buyers at 8 a.m. She knows that after eating, a person’s blood
who have limited funds to spend. They also offer low- sugar normally increases for a few hours. This is why
interest loans to buyers who qualify. blood sugar tests are usually ordered when the patient
• A cousin has an older car that he wants to sell. has not eaten for a number of hours. Linda reasons that
if she calculates the amount of insulin based on the
• There is a bus route within half a mile of her
temporarily elevated blood sugar levels, Mr. Gibbons
apartment.
will receive too much insulin and may have a nega-
• A local college offers a workshop that teaches people tive reaction. Linda calls Dr. Romero to clarify the order.
how to buy a car. Dr. Romero states that he believed the breakfast trays
• The local high school has an auto-mechanic training did not arrive until 8:30 a.m. He thanks Linda for catch-
program. For a small fee, students will check over ing the error and changes the order.
used cars before they are purchased. • What might have happened if Linda had simply
performed the blood sugar test exactly as ordered?
Step Three—Create Alternatives • Do you think Linda should have been considered
The third step in problem-solving is to create a list of responsible for the error if she had followed the
alternatives. Ideas for solutions and actions are gener- orders exactly?
ated based on the information collected. All possibilities • Review the five Ws and How questions in relation to
should be considered before one is selected. Some alter- this situation. Give examples of questions that Linda
natives may prove, on further investigation, to be imprac- may have asked herself.
tical or unworkable. It is essential to think through each
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Your Career in Health Care | 9
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10 | Chapter 1
• Assistant: associate’s degree, vocational training, or Professionals who use this term in their title include regis-
on-the-job training. Example of occupations: physi- tered nurse, registered respiratory therapist, and registered
cal therapist assistant medical assistant. (A profession may require registration,
• Aide: vocational training, on-the-job-training. but not include that term in the title.)
Examples of occupations: home health aide, psychi- Licensure is a designation that means the person has
atric aide. been granted permission to legally perform certain acts.
Licenses are granted by government agencies, often the
It is important to note that in spite of these general cat-
state. The specific occupations that require licensure
egories, the occupational title does not necessarily indicate
vary from state to state. Some occupations are licensed
the level of education required. For example, most states
in most, but not all, states. The word licensed does not
require a physical therapist assistant to have a 2-year asso-
usually appear with the title of licensed professions. For
ciate’s degree. However, becoming a veterinary assistant
example, in the following list of licensed professions, only
does not require a degree. For this reason, it is necessary to
one includes the term: dentist, dental hygienist, physician,
investigate the educational and certification requirements
registered nurse, and licensed practical/vocational nurse.
for any job in which you are interested.
The various types of approvals can be confusing.
A current trend is that on-the-job training, in which individ-
Certification and registration are often, but not always,
uals learn necessary job skills after being employed, is being
required to work legally. Even when not required by law,
replaced in many occupations by formal training. For example,
they provide credibility and are preferred by many employ-
aide-level positions are being assigned more responsibilities,
ers when hiring. Medical assisting is an example of an
and classroom training is becoming necessary. Today’s health
occupation in which voluntary certification or registration
care facilities need individuals who have current skills, are able
enhances the graduate’s chances of being hired. Licensure,
to think for themselves, and can start immediately as contrib-
if required for a profession, is never voluntary.
uting members of the health care team.
Some professions have more than one form of approval.
Medical assistants, for example, can be either certified or
Standards for Health Care Professionals registered. Both approvals require meeting specific edu-
Standards for health care professionals have been estab- cational requirements and passing a national exam. The
lished to protect the public from potential harm caused American Association of Medical Assistants grants the title
by incompetence. Testing, along with various approval and “certified.” The American Medical Technologists grants the
monitoring mechanisms, have been developed to deter- title “registered.”
mine whether professionals have met specific standards. Certification and licensing exams vary by occupation.
The purpose of standards is to ensure that professionals Some consist of multiple-choice questions that are pre-
master at least the minimum knowledge and skills neces- sented in a computerized format. Others contain case studies
sary to safely and competently practice their professions. and ask questions to test the candidates’ knowledge about
Students should be aware that in addition to knowledge handling situations that may be encountered on the job. Still
and skill standards, some occupations require background others have a practical component that requires c andidates
checks and drug testing. Individuals who have been con- to demonstrate their ability to perform certain tasks. In addi-
victed of certain crimes are prohibited from taking certifi- tion to occupational questions, some states test the knowl-
cation exams or practicing certain occupations. edge of the laws that apply to health care occupations.
Standards may be set by state boards or national pro- Another point that can be confusing is that some pro-
fessional organizations. There are several terms that desig- fessions are licensed but use the title “registered.” Nurses
nate various types of approvals. Certification is a general take a national exam that, when passed, entitles them to
term that means a person has met predetermined stan- apply for a license in the state where they want to work.
dards. The process of becoming certified usually involves They can become licensed in any state as long as they fol-
completing certain educational requirements and passing low the proper application process. In addition, they are
a professional examination. Most individuals who work in listed in a registry. Although “registered nurse” is the title
health care go through a certification process, although for the occupation, it is also a licensed profession.
their title might not include the term certified. Examples Study the contents of Tables 1–8 and 1–9. Note the vari-
of occupations that do include this term in their title are ety of titles and educational levels within the nursing and
certified occupational therapy assistant, certified medical occupational therapy careers. As you can see, professional
assistant, and certified nursing assistant. titles and the types of approval granted do not necessar-
Some occupations require registration, which means ily indicate the level of education achieved. For example,
being placed on an official list (registry) after meeting the the educational requirements for a certified nursing assis-
educational and testing requirements for the profession. tant can be less than 200 hours of instruction; a certified
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Your Career in Health Care | 11
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12 | Chapter 1
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Your Career in Health Care | 13
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14 | Chapter 1
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Your Career in Health Care | 15
Box 1–2
Medical Specialists
Physicians who specialize in treating specific parts of the body:
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16 | Chapter 1
Box 1–2
Physicians who work with specific populations:
Family Practice Physician Promotes wellness and treats individuals in all age groups
Gerontologist Promotes wellness and treats older persons
Obstetrician Assists women with pregnancy and childbirth
Pediatrician Promotes wellness and treats children
answering the telephone, maintaining patient records, and treating substance abuse problems, group homes, and
handling insurance and billing duties. In small offices, the prisons. Diagnoses encountered range from mild anxiety
medical assistant may have both front and back office assign- disorders, in which patients experience temporary feelings
ments. Medical assistants must be able to follow directions, of distress, to serious conditions, such as schizophrenia,
work accurately, get along well with others, and have good that result in behaviors that are unsafe for both the patient
manual dexterity. The occupation is expected to grow much and the public. (See Table 1–7.)
faster than average for all occupations at 29%. See https://
www.bls.gov/ooh/healthcare/medical-assistants.htm. Psychiatric/Mental Health Technician
Mental health technicians work with patients under the
Mental Health Occupations direction of a psychiatrist, a psychologist, or a registered
Mental health professionals provide care, treatment, coun- nurse. They carry out care plans, assist with group activities,
seling, and activities for patients with mental, emotional, listen to patients and provide encouragement, and note
and/or psychosocial (combination of mental and social) behavior. The work requires a strong desire to help others,
problems. These services are provided for patients in a patience, understanding, excellent oral communication skills,
wide variety of settings, including medical offices dedi- and emotional stability. Employment growth is expected to
cated to the practice of psychiatry, psychiatric hospitals, be 6%, about average for all occupations. See https://www.bls
halfway houses, general hospitals, clinics dedicated to .gov/ooh/healthcare/psychiatric-technicians-and-aides.htm.
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Your Career in Health Care | 17
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18 | Chapter 1
Licensed Practical/Vocational Nurse vary by region. Most new jobs are in residential care facili-
Licensed practical nurses (known as licensed vocational ties and home health environments. Employment growth
nurses in California and Texas) provide basic patient care is expected to be faster than average for all occupations
under the direction of physicians and registered nurses. at 12%. See https://www.bls.gov/ooh/healthcare/licensed-
Most practical nurses carry out bedside tasks that include practical-and-licensed-vocational-nurses.htm.
taking vital signs, administering medications, applying
dressings and hot and cold packs, treating bedsores, and Certified Nursing Assistant
giving various comfort measures. They are also responsible Nursing assistants work under the supervision of nursing
for recording patient information. Practical nurses must be staff to help care for patients’ basic needs. They may take
caring, responsible, emotionally stable, and able to follow vital signs, assist patients with hygiene and feeding, give
directions and work under supervision. Job opportunities comfort measures, change bedding, and help transport
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Your Career in Health Care | 19
© Rob Marmium/Shutterstock.com.
© Tyler Olson/Shutterstock.com.
FIGURE 1–5 As older nurses retire, there will be a great need
FIGURE 1–6 Home health aide is a fast-growing occupation.
for newly trained registered nurses.
Aides must be compassionate, patient, and interested in
helping older adults and people with disabilities.
patients. The variety and level of duties depend on state medications. Because of the aging population, this is one
laws, the amount of training, and the needs of the facility. of the fastest growing of all occupations, projected to be
Assistants must be patient, caring, dependable, and able to 39%. See https://www.bls.gov/ooh/healthcare/home-health-
follow directions. This is a fast-growing occupation, with an aides-and-personal-care-aides.htm.
expected increase of 18%. This is especially true for individu-
als who are also qualified to work as home health aides. See Occupational Therapy Occupations
https://www.bls.gov/ooh/healthcare/nursing-assistants.htm.
The purpose of occupational therapy is to help individuals
Patient Care Technician attain the highest level of function and self-sufficiency pos-
The work of patient care technicians is similar to that of sible. Difficulties in performing the activities of daily living
nursing assistants. They work under the supervision of phy- can be the result of physical, mental, or emotional problems
sicians or nurses, taking vital signs, collecting specimens, caused by disease, injury, or congenital (present at birth)
and assisting patients with eating, hygiene, and grooming. conditions. Occupational therapists evaluate patients, set
Patient care technicians work in hospitals, clinics, and reha- goals to increase their function and lessen their limitations,
bilitation facilities. See https://www.bls.gov/ooh/healthcare and create treatment plans to achieve these goals. Treatment
/nursing-assistants.htm. may involve individual or group activities, exercise, provid-
ing adaptive equipment such as splints and special tools,
Home Health Aide and teaching patients new ways to perform daily tasks. Job
Home health aides help people with disabilities, older adults, growth rate for occupational therapists is projected at 24%,
and the chronically ill. Their work is similar to that of certi- much faster than other occupations. (See Table 1–9.)
fied nursing assistants. In fact, many home health aides have
Occupational Therapy Assistant
nursing assistant certification. They may work in patients’
homes or in a care facility, assisting with moving patients, Occupational therapy assistants work under the supervi-
providing personal care, and dressing. In the client’s home, sion of occupational therapists. They carry out rehabilita-
duties may include preparing meals, providing companion- tive activities and exercises prescribed in treatment plans
ship, doing light housekeeping, and providing transporta- prepared by occupational therapists. Other important
tion. In some states, with the proper training and under the duties include patient education, monitoring patient prog-
supervision of a nurse, they are allowed to give medications ress, and preparing reports for the therapist. Typical tasks
to clients, take vital signs, and assist patients with prescribed include teaching a patient to use special devices that enable
exercises. This is one of the fastest growing of all occupa- the performance of everyday tasks, such as reaching, dress-
tions, at 47%. (See Figure 1–6.) See https://www.bls.gov/ooh ing, and cooking; assisting with a stretching exercise; and
/healthcare/home-health-aides-and-personal-care-aides.htm. making a hand splint. Occupational therapy assistants must
have good communication skills, be patient and caring, and
Personal Care Aide be sensitive to the needs of people who suffer from a vari-
Personal care aides help residents and patients with daily ety of disabilities. The number of new positions is expected
tasks such as bathing, grooming, dressing, and eating. They to grow rapidly at 29%. See https://www.bls.gov/ooh
cannot perform medically related tasks, such as giving /healthcare/occupational-therapy-assistants-and-aides.htm.
Copyright 2021 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.
20 | Chapter 1
Occupational Therapy Aide faster than average for all occupations, at 12% especially for
Aides help therapists and assistants by performing sup- technicians who are certified. See https://www.bls.gov/ooh
portive duties such as preparing supplies for activities, /healthcare/pharmacy-technicians.htm.
assisting with patient transfers, helping with patient treat-
ments and activities, and cleaning activity areas. Some Physical Therapy Occupations
aides are cross-trained to assist other rehabilitation profes- The purpose of physical therapy is to help patients improve
sionals such as physical therapists. Rehabilitation skills may their physical functions by increasing muscle strength,
be combined with nursing assistance training and certifica- range of motion, movement, and by decreasing pain. This
tion. Aides must be responsible and able to follow direc- is accomplished through assessment and the creation and
tions. For aides who are also certified nursing assistants, implementation of treatment programs that may include
the number of positions is expected to grow rapidly. See exercise, massage, and the use of modalities such as heat,
https://www.bls.gov/ooh/healthcare/occupational-therapy- cold, and electrical stimulation. Physical therapists teach
assistants-and-aides.htm. patients to perform exercises and use equipment, such as
canes and crutches. (See Table 1–11 and Figure 1–7.)
Pharmacy Occupations
Pharmacy professionals prepare and dispense medications Physical Therapist Assistant
to promote patient wellness and recovery, as well as phar- Assistants work with patients under the supervision of
maceutical products used to diagnose health conditions. a physical therapist to carry out treatment plans. They
Important duties also include educating patients about the teach and supervise exercises, apply modalities, perform
proper use of medications and ensuring that patients are massages, assist patients with ambulatory devices such
not given drugs that will cause harm because of allergic as walkers and canes, and document progress. Physical
reactions or negative interactions with other drugs. (See therapist assistants must be patient and encouraging
Table 1–10.) and have the physical strength to assist patients with
e xercises. This occupation is projected to be among
Pharmacy Technician the fastest growing in the next several years at 29%.
Pharmacy technicians work under the supervision of a See https://www.bls.gov/ooh/healthcare/physical-therapist-
licensed pharmacist. They fill orders for drugs, stock medi- assistants-and-aides.htm.
cation carts, record and store incoming drug supplies, and
reorder inventory as needed. They also assist in maintain- Physical Therapist Aide
ing paperwork and records required for controlled drugs Aides support the work of therapists and assistants by pre-
(drugs that have potential for abuse). Pharmacy technicians paring and cleaning equipment and therapy areas, assist-
must be responsible, detail oriented, and able to follow ing with treatments, transporting patients, and ordering
directions exactly. Job opportunities are expected to grow and maintaining supplies. Aides must be responsible and
Copyright 2021 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.
Your Career in Health Care | 21
able to follow directions. Job growth is expected to be heart disease, acute diseases (lasting a short time but are
much faster than average. See https://www.bls.gov/ooh relatively severe) such as pneumonia, or chronic diseases
/healthcare/physical-therapist-assistants-and-aides.htm. (lasting a long time) such as emphysema. (See Table 1–12
and Figure 1–8.)
Respiratory Therapy Occupations
Respiratory therapy involves evaluating, treating, and Respiratory Therapist
caring for patients with breathing disorders. Respiratory Respiratory therapists perform a variety of tasks to assist
therapists assist patients who have difficulty breathing or patients with breathing. These include using special
cannot breathe on their own because of conditions such as instruments to measure lung capacity and drawing blood
Copyright 2021 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.
22 | Chapter 1
Copyright 2021 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.
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