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Updated Eighth Edition
Simmers
DHOHealth Science
Louise Simmers, BSN, MEd, RN

Karen Simmers-Nartker, BSN, RN
Sharon Simmers-Kobelak, BBA
Australia • Brazil • Japan • Korea • Mexico • Singapore • Spain • United Kingdom • United States
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).
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Health Science, Updated 8th Edition © 2017, 2014, 2009, 2004, 2001, 1997 Cengage Learning
Louise Simmers, BSN, MEd, RN WCN: 02-200-203
Karen Simmers-Nartker, BSN, RN
ALL RIGHTS RESERVED. No part of this work covered by the copyright herein
Sharon Simmers-Kobelak, BBA
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Printed in the United States of America

Print Number: 01
Print Year: 2015
Contents
Preface ix
About the Authors xiv
How to Use This Textbook xv
Supplements at a Glance xix
Acknowledgments xx
Part 1 Basic Health Care Concepts and Skills 2

CHAPTER 1 History and Trends of Health Care 4
Chapter Objectives 4 Today’s Research: Tomorrow’s Health Care 27
Key Terms 4 Summary28
1:1 History of Health Care 5 Internet Searches 28
1:2 Trends in Health Care 18 Review Questions 29
CHAPTER 2 Health Care Systems 30

Chapter Objectives 30 2:5 Health Insurance Plans 36
Key Terms 30 Today’s Research: Tomorrow’s Health Care 40
2:1 Private Health Care Facilities 31 Summary41
2:2 Government Agencies 34 Internet Searches 41
2:3 Voluntary or Nonprofit Agencies 35 Review Questions 42
2:4 Organizational Structure 35
CHAPTER 3 Careers in Health Care 43

Chapter Objectives 43 3:2H Veterinary Careers 61
Key Terms 43 3:2I Vision Services Careers 63
3:1 Introduction to Health Care Careers 45 3:2J Other Therapeutic Services Careers 64
3:2 Therapeutic Services Careers 48 3:3 Diagnostic Services Careers 70
3:2A Dental Careers 51 3:4 Health Informatics Careers 74
3:2B Emergency Medical Services Careers 52 3:5 Support Services Careers 77
3:2C Medical Careers 54 3:6 Biotechnology Research and
3:2D Mental Health Services and Social Development Careers 79
Services Careers 56 Today’s Research: Tomorrow’s Health Care 81
3:2E Mortuary Careers 58 Summary82
3:2F Nursing Careers 59 Internet Searches 82
3:2G Nutrition and Dietary Services Careers 61 Review Questions 82
iii
iv C O n te n ts
CHAPTER 4 Personal and Professional Qualities

of a Health Care Worker 83
Chapter Objectives 83 4:6 Professional Leadership 95
Key Terms 83 4:7 Parliamentary Procedure 96
Introduction 84 4:8 Stress 99
4:1 Personal Appearance 84 4:9 Time Management 101
4:2 Personal Characteristics 86 Today’s Research: Tomorrow’s Health Care 103
4:3 Effective Communications 87 Summary 104
4:4 Interpersonal Relationships 93 Internet Searches 105
4:5 Teamwork 94 Review Questions 105
CHAPTER 5 Legal and Ethical Responsibilities 106

Chapter Objectives 106 5:5 Professional Standards 118
5:1 Legal Responsibilities 107 Summary 121
5:2 Ethics 113 Internet Searches 121
5:3 Patients’ Rights 114 Review Questions 122
5:4 Advance Directives for Health Care 116
CHAPTER 6 Medical Terminology 123

Key Terms 123 Summary 143
6:1 Interpreting Word Parts 123 Internet Searches 144
6:2 Using Medical Abbreviations 134 Review Questions 144
CHAPTER 7 Anatomy and Physiology 145

Chapter Objectives 145 7:9 Lymphatic System 200
Key Terms 145 7:10 Respiratory System 202
7:1 Basic Structure of the Human Body 146 7:11 Digestive System 209
7:2 Body Planes, Directions, and Cavities 153 7:12 Urinary System 217
7:3 Integumentary System 156 7:13 Endocrine System 221
7:4 Skeletal System 161 7:14 Reproductive System 228
7:5 Muscular System 168 Today’s Research: Tomorrow’s Health Care 237
7:6 Nervous System 173 Summary 238
7:7 Special Senses 183 Internet Searches 238
7:8 Circulatory System 190 Review Questions 239
CHAPTER 8 Human Growth and Development 240

Chapter Objectives 240 8:3 Human Needs 255
Introduction 241 Summary 260
8:1 Life Stages 241 Internet Searches 261
8:2 Death and Dying 252 Review Questions 261
C O n te n ts v
CHAPTER 9 Cultural Diversity 262

Chapter Objectives 262 9:4 Respecting Cultural Diversity 276
9:1 Culture, Ethnicity, and Race 263 Summary 277
9:2 Bias, Prejudice, and Stereotyping 265 Internet Searches 277
9:3 Understanding Cultural Diversity 265 Review Questions 278
CHAPTER 10 Geriatric Care 279

Chapter Objectives 279 10:4 Confusion and Disorientation in the Elderly 290
Key Terms 279 10:5 Meeting the Needs of the Elderly 293
Introduction 280 Today’s Research: Tomorrow’s Health Care 295
10:1 Myths on Aging 280 Summary 295
10:2 Physical Changes of Aging 282 Internet Searches 296
10:3 Psychosocial Changes of Aging 288 Review Questions 296
CHAPTER 11 Nutrition and Diets 297

Chapter Objectives 297 11:5 Weight Management 308
Key Terms 297 11:6 Therapeutic Diets 312
11:1 Fundamentals of Nutrition 298 Today’s Research: Tomorrow’s Health Care 313
11:2 Essential Nutrients 299 Summary 314
11:3 Utilization of Nutrients 300 Internet Searches 315
11:4 Maintenance of Good Nutrition 304 Review Questions 315
CHAPTER 12 Computers and Technology in Health Care 316

Chapter Objectives 316 12:7 Research 329
Key Terms 316 12:8 Communication 330
12:1 Introduction 317 12:9 Using the Internet 332
12:2 Information Systems 317 12:10 Computer Protection and Security 333
12:3 Diagnostics 321 Today’s Research: Tomorrow’s Health Care 335
12:4 Treatment 324 Summary 336
12:5 Patient Monitoring 327 Internet Searches 336
12:6 Education 329 Review Questions 337
CHAPTER 13 Medical Math 338

Chapter Objectives 338 13:5 Systems of Measurement 351
Key Terms 338 13:6 Temperature Conversion 356
Introduction 339 13:7 Military Time 357
13:1 Basic Calculations 339 Today’s Research: Tomorrow’s Health Care 359
13:2 Estimating 349 Summary 359
13:3 Roman Numerals 349 Internet Searches 360
13:4 Angles 350 Review Questions 360
vi C O n te n ts
CHAPTER 14 Promotion of Safety 361

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
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
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.
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
My best friend and colleague, the late Nancy Web- Chiefland High School Academy of Health Related
ber, RN, who taught health science education with Professions
me for over 20 years and critiqued many chapters of Chiefland, Florida
this textbook
Beth Hardee
Carolynn Townsend, Lisa Shearer Cooper, Donna Director, Fire and EMS Academy at the
Story, Dorothy Fishman, Dakota Mitchell, and Lee Professional Academies Magnet at Loften High
Haroun who contributed chapter information School, Gainesville, Florida
The author and Cengage Learning would like to Mrs. Randi Hunewill, NDOE, NREMT-I
thank those individuals who reviewed the manuscript Nevada Department of Education Health Science
and offered suggestions, feedback, and assistance. The Consultant
text has been improved as a result of the reviewers’ help-
ful, insightful, and creative suggestions. Their work is Grant Iannelli, DC
greatly appreciated. Professor of Chiropractic Medicine
National University of Health Sciences
Nancy H. Allen Lombard, Illinois
Health Science Education Associate
South Carolina Department of Education Kathleen Iannucci, LAc, PTA, LMT
Office of Career and Technology Education Adjunct Professor, Palm Beach State College
Columbia, South Carolina Boca Raton, Florida
xx
A ck n owledgme n ts xxi
Thalea J. Longhurst Karen Ruble Smith, RN, BSN

Health Science Specialist Health Science Consultant/Biomedical Science State
Career, Technical, and Adult Education Leader
Utah State Office of Education High Schools That Work Coordinator
Salt Lake City, Utah Kentucky Department of Education
College & Career Readiness
Clarice K.W. Morris, PhD Frankfort, Kentucky
Coordinator, Academy of Medical Professions,
Charles E. Gorton High School Kathy B. Turner, RN, BSN
Yonkers, New York Assistant Chief, Health Care Personnel Registry
Division of Health Service Regulation
Amy Parker-Ferguson, MEd, BS, RN, LP, NREMT-P Raleigh, North Carolina
Chief Nursing Officer for Dallas Medical Center
Adjunct Faculty, Dallas Community College Jackie Uselton, RDH, CPhT, MEd
Dallas, Texas Health Science Instructor
TEKS Trainer, HOSA Advisor
Anne B. Regier, RDH, BS THOA Inc. Board of Directors
Health Science Coordinator Austin, Texas
J. Frank Dobie High School
Pasadena I.S.D. The author also wishes to thank the following com-
Houston, Texas panies, associations, and individuals for information and/
or illustrations.
Linda Roberts
Teacher Nampa School District Health Professions Air Techniques, Inc.
Academy American Cancer Society
Nampa, Idaho
Atago, USA
Christa G. Ruber, EdD
Department Head, Allied Health Becton Dickinson
Pensacola State College Timothy Berger, MD
Pensacola, Florida
Bigstock
Debra A. Sawhill, RN, BAEd, CMA-AAMA Bruce Black, MD
OEA-NEOEA, AAMA,
SkillsUSA Advisor, American Red Cross Instructor Brevis Corporation
Program Coordinator for Portage Lakes Career Briggs Corporation
Center NATCEP
Program Instructor for Portage Lakes Career Center Marcia Butterfield
Health Care Academy Carestream Health
Uniontown, Ohio
Care Trak International, Inc.
Lara Skaggs Carson’s Scholar Fund
State Program Manager, Health Careers Education
Oklahoma Department of Career and Technology Centers for Disease Control and Prevention
Education Chart Industries, Inc.
Stillwater, Oklahoma
Sandy Clark
Elisabeth A. Smith, RN, EdS
The Clorox Company
National Academy Foundation (NAF) Academy of
Health Science Control-o-fax Office Systems
CNA Program Coordinator and Instructor
Covidien
William R. Boone High School
Orlando, Florida DMG America
xxii A ck n owledgme n ts
Dynarex Omron Healthcare

Empire Blue Cross/Blue Shield Pfizer
Food and Drug Administration (FDA) Physicians’ Record Company
Deborah Funk, MD Polara Studios
Steve Greg, DDS Poly-Medco
Hager Worldwide Practicon
HOSA: Future Health Professionals Quinton Cardiology, Inc.
HemoCue® Sage Products, Inc.
Hu-Friedy Manufacturing Company Salk Institute
Integra Miltex Science Photo Library, David Martin, MD
Invacare Shutterstock
Iris Sample Processing Company Robert A. Silverman, MD
i-Stock SkillsUSA
J.T. Posey Company Smead Manufacturing
Kardex Systems Spacelabs Medical, Inc.
Kerr Corporation SPS Medical
McKesson Automation Solutions Statlab Medical Products
Medical Indicators, Inc. STERIS Corporation
Medline Industries Ron Stram, MD
Midmark Corporation Sunrise Medical
Miltex Instrument Company Larry Torrey
National Archives, Brady Collection Unico
National Cancer Institute UPI/Newscom
National Consortium for Health Science Education U.S. Administration on Aging
National Eye Institute U.S. Army
National Hospice and Palliative Care Organization U.S. Department of Agriculture
National Institutes of Health U.S. Postal Systems
National Library of Medicine Vertex-42
National Multiple Sclerosis Society Victorian Adult Burns Service, Melbourne, Australia
National Pressure Ulcer Advisory Panel W. A. Baum Company, Inc.
National Uniform Claim Committee Wake Forest Institute for Regenerative Medicine,
Dr. Atala
NexTemp
Winco
Nonin Medical, Inc.
Zuma Press/Newscom
NPS Corporation
1 Basic Health Care
PA RT
Concepts and Skills

Welcome to the world of health science education. You have chosen a
career in a field that offers endless opportunities. If you learn and master
the knowledge and skills required, you can find employment in any number
of rewarding careers.
There will always be a need for workers in health care careers because
such workers provide services that cannot be performed by a machine.
Thus, although the future will bring changes, you will always be an impor-
tant part of providing needed care or services.
The material that follows will give you a good start toward your career
goal. As you learn to use the information presented in the following pages,
always be willing to continue to learn and to grow. All material is presented
in a manner to make learning as easy as possible. However, you must still
make the effort to achieve the standards set and to perform to the best of
your ability.
You will find this text different from previous texts that you have used.
If you read the pages that begin each part, you will understand how to use
this text. You will likely enjoy working with it because it will allow you to
constantly see how much progress you are making. In addition, it is prob-
ably the only text you will have used that allows you to practice tests or
evaluations before you actually take them.
One final word. You are entering a field that provides one of the great-
est rewards: that of working to assist others. Although the work is hard at
times, you will always have the satisfaction of knowing that you are helping
other people. So be proud of yourself. When you learn the concepts and
skills well, you will provide services that are appreciated by all.
Introduction
This part is divided into 18 chapters, each covering several topics designed
to provide you with the basic knowledge and skills required for many dif-
ferent health careers. Before starting a chapter, read the o bjectives so you
will know exactly what is expected of you. The o bjectives identify the com-
petencies you should have mastered upon completing the chapter.
Health Science, updated 8th edition, has a textbook and a workbook.
Each chapter in the textbook is subdivided into information sections about
specific topics. At the end of most of these sections is a statement telling
you to go to the workbook to complete an assignment sheet on the infor-
mation covered. Some chapters also include Procedure sections, each of
2
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
assignment sheet. Refer back to the text to see if your answers are correct.
Let your instructor grade your completed assignment sheets. Note any
changes or corrections. Be sure you understand the information before
moving to another topic or performing the corresponding procedure.
3. Procedure Sections (Textbook): The Procedure sections provide step-by-
step instructions on how to perform the procedures. Follow the steps
while you practice the procedures. Each procedure begins with a list
of the necessary equipment and supplies. On occasion, you will see
any or all of the following three words in the procedure sections: NOTE,
CAUTION, and CHECKPOINT. NOTE means to carefully read the comments
following, which usually stress points of knowledge or explain why cer-
tain techniques are used. CAUTION means that a safety factor is involved
and that you should proceed carefully while doing the step in order to
avoid injuring yourself or the patient. CHECKPOINT means to ask your
instructor to check you at that point in the procedure. Checkpoints are
usually located at critical points in the procedures. Each procedure sec-
tion refers you to a specific evaluation sheet in the workbook.
4. Evaluation Sheets (Workbook): Each evaluation sheet contains a list of cri
teria on which you will be tested when you have mastered a particular
procedure. Make sure that your performance meets the standards set.
When you feel you have mastered a particular procedure, sign the evalua-
tion sheet and give it to your instructor. Your instructor will grade you by
using the listed criteria and checking each step against your performance.
In addition to these components, you will also find a References list at the
end of the textbook. For additional information about the topics discussed,
refer to these references.
Finally, you will notice various icons throughout the textbook. Their pur-
pose is to accentuate particular factors or denote specific types of knowledge.
The icons and their meanings are:
Observe Standard Precautions Science Skill
Precaution Science
Instructor’s Check—Call Instructor at This Point Career Information

Check Career
Safety—Proceed with Caution Comm

Communications Skill
Safety
OBRA Requirement—Based on Federal Law Technology

Technology
OBRA
for Nurse Assistant Health Insurance Portability
HIPAA
Math Skill and Accountability Act
Math
Legal Responsibility Electronic Health Records

Legal EHR
1 History and Trends
of Health Care
CHAPTER OBJECTIVES
After completing this chapter, you should be able to:
• Differentiate between early beliefs about the causes of disease and treatment and current beliefs about dis-
ease and treatment.
• Identify at least 10 major events in the history of health care.
• Name at least six historical individuals and explain how each one helped to improve health care.
• Create a timeline showing what you believe are the 20 most important discoveries in health care and explain
why you believe they are important.
• Identify at least five current trends or changes in health care.
KEY TERMS
alternative therapies energy conservation Omnibus Budget Reconciliation
biotechnology geriatric care Act (OBRA)
complementary therapies holistic health care outpatient services
cost containment home health care pandemic
diagnostic related groups integrative (integrated) telemedicine
(DRGs) health care wellness
Note: To further emphasize the Key Terms, they appear in color within the chapter. You will notice beginning
in Chapter 3 on page 43 that pronunciations have been provided for the more difficult key terms. The single
accent mark, _'_, shows where the main stress is placed when saying the word. The double accent, _"_,
shows secondary stress (if present in the word).
4
H istory a n d T re n d s o f H ea l th C are 5
1:1 History of Health Care BIOGRAPHY

Why is it important to understand the history of health
care? Would you believe that some of the treatment
Hippocrates
methods in use today were also used in ancient times? In Hippocrates (ca. 460–377 bc) was a Greek physician who
the days before drug stores, people used many herbs and is called the “Father of Medicine.” He is best known for
plants as both food and medicine. Many of these herbs authoring a code of conduct for physicians, the “Hippocratic
remain in use today. A common example is a medica- Oath.” The oath began as a swearing to the healing gods to
tion called morphine. Morphine is made from the poppy practice medicine following a strict code of ethics. Through
plant and is used to manage pain. As you review each the years, the oath has been modernized and no longer
period of history, think about how the discoveries made involves swearing to the gods. Most schools of medicine
in that period have helped to improve the health care still use some form of the oath, and it is a rite of passage to
you receive today. practicing medicine in many countries.
The ancient Greeks thought that illness and disease
were caused by the disfavor of the gods or evil spirits. Hip-
Ancient Times pocrates’ beliefs led medicine in a more accurate direction.
Table 1–1 lists many of the historical events of health care He believed that illness and disease had rational and physi-
in ancient times. In primitive times, the common belief cal explanations.
was that disease and illness were caused by evil spirits Hippocrates stressed the importance of observation,
and demons. Treatment was directed toward eliminat- diagnosis, and treatment. He was the first to accurately
ing the evil spirits. As civilizations developed, changes describe symptoms of pneumonia and epilepsy in children.
occurred as people began to study the human body and He encouraged the use of a good diet, fresh air, cleanli-
make observations about how it functions. ness, and exercise to help the body heal itself.
Religion played an important role in health care. Hippocrates founded a medical school in Cos, Greece,
A common belief was that illness and disease were pun- to teach his ideas about medicine. His students were held
ishments from the gods. Religious rites and ceremo- to a strict ethical code of behavior; this oath is the basis of
nies were frequently used to eliminate evil spirits and medical practice today.
restore health. Exploring the structure of the human
body was limited because most religions did not allow
dissection, or cutting the body apart. For this reason,
animals were frequently dissected to learn about differ-
ent body parts.
The ancient Egyptians were the first people to keep
health records. It is important to remember that many
people could not read; therefore, knowledge was limited
to an educated few. Most of the records were inscribed
on stone and were created by priests, who also acted
as physicians.
The ancient Chinese strongly believed in the need to
cure the spirit and nourish the entire body. This form of
treatment remains important today, when holistic health
methods stress treating the entire patient—mind, body,
and soul. Chinese herbal medicine, acupuncture, and
massage (Tui na) are still commonly used.
Hippocrates (ca. 460–377 bc), called the “Father of Image courtesy National Library of Medicine
Medicine,” was one of the most important physicians in
ancient Greece (see the Biography box for more infor
mation about Hippocrates). The records that he and The Rod of Asclepius (Figure 1–1A), the Greek
other physicians created helped establish that disease s ymbol associated with medicine and healing, originated
is caused by natural causes, not by supernatural spirits in ancient Greece. The caduceus symbol (Figure 1–1B)
and demons. The ancient Greeks were also among the is often mistaken as the medical symbol, but it is actu-
first to stress that a good diet and cleanliness help to ally the symbol for commerce. In Greek mythology,
prevent disease. Asclepius was believed to be the son of Apollo and the
Another random document with
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TOM.
I now come to the very prince of pets, the one of all I ever had the
most noble and most dear,—Tom, a Newfoundland setter, the
favorite dog of my brother Albert. He has been a member of our
family for five or six years past. We brought him from the city to our
pleasant village home in Pennsylvania, where we now live.
Tom is a dog of extraordinary beauty, sagacity, and good feeling. He
is very large, and, with the exception of his feet and breast, jet black,
with a thick coat of fine hair, which lies in short curls, glossy and
silken. He has a well-formed head, and a handsome, dark eye, full of
kindness and intelligence. His limbs are small, and his feet
particularly delicate. He is, I am sorry to say, rather indolent in his
habits, always prefers to take a carriage to the hunting-ground, when
he goes sporting with his master, and he sleeps rather too soundly at
night to be a good watch-dog. We make him useful in various ways,
however, such as carrying baskets and bundles, and sometimes we
send him to the post-office with and for letters and papers. These he
always takes the most faithful care of, never allowing any one to look
at them on the way. He is a remarkably gentlemanly dog in his
manner, never making free with people, or seeming too fond at first
sight; but if you speak to him pleasantly, he will offer you a friendly
paw in a quiet way, and seem happy to make your acquaintance. He
never fawns, nor whines, nor skulks about, but is dignified, easy, and
perfectly at home in polite society. He is a sad aristocrat, treats all
well-dressed comers most courteously, but with shabby people he
will have nothing to do. Tom knows how to take and carry on a joke. I
recollect one evening, when we had visitors, and he was in the
parlour, I put on him a gay-colored sack of my own, and a large
gypsy hat, which I tied under his throat. Instead of looking ashamed
and trying to get these off, as most dogs would have done, he
crossed the room and sprang on to the sofa, where he sat upright,
looking very wise and grave, like some old colored woman at church.
The illustrious General Tom Thumb once travelled with my brother
and this dog, and, falling very much in love with his namesake,
offered any price for him. Of course, my brother would not think for a
moment of selling his faithful friend, and even had he felt differently, I
doubt very much whether Tom, who had been used to looking up to
full-grown men, would have shown much obedience or respect, for
such a funny little fellow as the General. It was amusing to observe
the dog’s manner toward his small, new acquaintance. He was kind
and condescending, though he sometimes seemed to think that the
General was a little too much inclined to take liberties with his
superiors in age and size,—rather more forward and familiar than
was quite becoming in a child.
Two or three years ago, Tom was the beloved playfellow of my
brother Frederic’s youngest daughter,—our little Jane. She always
seemed to me like a fairy-child, she was so small and delicate, with
such bright golden curls falling about her face,—the sweetest face in
the world. It was beautiful to see her at play with that great, black
dog, who was very tender with her, for he seemed to know that she
was not strong. One evening she left her play earlier than usual, and
went and laid her head in her mother’s lap, and said, “Little Jane is
tired.” That night she sickened, and in a few, a very few days she
died. When she was hid away in the grave, we grieved deeply that
we should see her face no more, but we had joy to know that it
would never be pale with sickness in that heavenly home to which
she had gone; and though we miss her still, we have great
happiness in the thought that she will never be “tired” any more, for
we believe her to be resting on the bosom of the Lord Jesus.
One day last spring, I remember, her mother gave me a bunch of
violets, saying, “They are from the grave of little Jane.” I suppose
they were like all other blue violets, but I thought then I had never
seen any so beautiful. It seemed to me that the sweet looks of the
child were blooming out of the flowers which had sprung up over the
place where we had laid her.
Tom seems much attached to all our family, but most devotedly so to
my brother Albert. They two have hunted very much together, and
seem equally fond of the sport. If Tom sees his master with his
hunting-dress on, and his fowling-piece in hand, he is half beside
himself with joy. But when he returns from the hunt, spent and weary,
he always comes to me to be fed and petted.
You will remember that years have passed by since this brother and I
were schoolmates and playmates together. He is now a fine young
man, while I am a full-grown woman, who have seen the world I
used to think so grand and glorious, and found it—no better than it
should be. But of my brother. He is our youngest, you know, and so
has never outgrown that peculiar fondness, that dear love, we
always give to “the baby.” While I have been writing these histories,
and recalling in almost every scene the playmate of my childhood, I
can only see him as a boy,—a little black-eyed, rosy-cheeked boy; it
is very difficult to think of him as a man, making his own way bravely
in the world. Last spring we observed that dear Albert’s bright face
had become very thoughtful and serious; we knew that something
was weighing on his mind, and finally it came out. He was about to
leave us all for a long time, it might be for ever; he was going to
California! We were very unhappy to hear this, but, as it was on
some accounts the best thing that my brother could do, we finally
consented, and all went to work as cheerfully as we could to help
him off.
It was a bright May morning when he left, but it seemed to us that
there never was a darker or sadder day. The dear fellow kept up
good courage till it came to the parting; then his heart seemed to
melt and flow out in his tears, fast dropping on the brows and necks
of his mother and sisters, as he held them for the last time to his
heaving breast. But I will not dwell on this parting, for my own eyes
grow so dim I cannot well see to write.
I remember that poor Tom seemed greatly troubled that morning; he
knew that something sad was happening, and looked anxiously in
our faces, as though he would ask what it was; and when my brother
patted him on the head, bade him good by, and passed out of the
gate, forbidding him to follow, the faithful creature whined sadly, and
looked after him wistfully, till he was out of sight.
After Albert had been gone about an hour, I remember that I went up
into his room, and sat down in his favorite seat, by the window. O,
how still and lonely and mournful it seemed there! Near me hung my
brother’s fencing-sword and mask, which he had used only the day
before,—on the floor lay the game-bag, which he had always worn in
hunting, and which he had flung out of his trunk, not having room for
it. This brought my merry brother before me more clearly than any
thing else. I took it up and held it a long time, mourning at heart, but I
could not weep. Suddenly I heard a low whine in the hall, and Tom
stole softly into the room. He came to me and laid his head in my
lap; but when he saw the game-bag there, he set up a most mournful
cry. Then I flung my arms about him, bowed my head down against
his neck, and burst into tears. I forgot that he was a poor dumb
brute, and only remembered that he loved my brother, and my
brother loved him, and that he mourned with me in my sorrow. After
this, it was very affecting to see Tom go every day, for a long while,
to the gate, out of which he had seen his master pass for the last
time, and then stand and look up the street, crying like a grieved
child.
As you will readily believe, Tom is now dearer than ever to us all; we
cannot see him without a sweet, sad thought of that beloved one so
far away. I am not now at home, but I never hear from there without
hearing of the welfare of the noble dog which my brother, in going,
bestowed upon me.
SUPPLEMENTARY STORIES.
It is twenty years since the first part of this little volume was
published. The dear children for whom those simple stories of my
childhood were told are men and women now, and wonderful
changes have taken place in all our lives and in all the world. But in
growing old I have not lost any thing of my old love of pets; and I
hope that my little readers of this time will understand and share that
feeling. I hope that you, dear boys and girls, look on all innocent
dumb creatures about you as friends, and have not only a kindly
interest in them, but respect them for all that is lovely and wonderful
in their brief existences, and as objects of the unceasing care and
tenderness of our Father in heaven. Every smallest creature that
lives represents a thought of God,—was born out of his great, deep,
infinite life.
I hope you especially like to hear about dogs and cats, birds and
chickens, for it is of them that I have a few new stories to relate, as
true as they are amusing or marvellous.
FIDO THE BRAVE.
First I must relate the somewhat tragical history of a certain little

shaggy brown-and-white spaniel belonging to some friends of ours in
the country. He was a stray dog, and came to them in a very forlorn
condition, and had evidently been vagabondizing about in the fields
and woods for some days, for he was ravenously hungry, and his
long hair was dirty, and stuck full of straws, briers, and burrs, till he
bristled like a hedgehog. The first thing that the kind lady did, after
feeding him, was to put him into a warm bath. Then she set herself
to work to rid him of his encumbrances,—sticks, straws, briers, and
burrs. It was a long time before she got down to the dog; but when at
last she laid down scissors, scrubbing-brush, and comb, and
deposited her poor protégé on the floor, he was a good deal
diminished in size, but looked really handsome, and very bright,
quaint, and droll.
He took at once to his new home, and soon became a great pet,
showing himself to be grateful, affectionate, and full of cleverness,
fun, and fire. His pluck was beyond all question. Though not
quarrelsome, he would, when in the least degree put upon, fight any
dog in the neighborhood, whatever his size and breed, and he
generally came off victorious. But he was altogether too rash and
venturesome, given to worrying cows, horses, hogs, and old
stragglers; rushing into all sorts of danger, and coming out, when he
did come out, and was not brought out, with his little eyes dancing
and his bushy tail in air, as though enjoying the risk of the thing, and
the terror of his kind mistress.
Among other sportive tricks was a way he had of running before the
locomotive when the train was coming in or going out of the station,
near by the house of my friends. Nearly every day he could be seen
frisking about it, dancing frantically up and down before it, and
barking valorously. He really seemed to take a malicious satisfaction
in defying and insulting that rumbling, puffing, snorting monster, that,
big as it was, ran away from him as fast as possible.
“The pitcher goes often to the well, but is broken at last.”
One fatal day the little spaniel miscalculated the speed of his big
enemy, and failed to get out of the way in time. He was all off the
track but one hind leg, when he was struck by the locomotive and
knocked into a ditch,—that one hind leg being pretty badly mashed,
you may believe. The poor little fellow set up a great outcry, but the
unfeeling engineer never stopped the train to attend to him, and the
railroad folks kept the accident out of the papers. Fido made his way
home all alone, dragging his mashed leg behind him. Though greatly
shocked, his mistress did not scold him, but sent for a surgeon, who,
after a careful examination, and consulting his books, decided that
an amputation was necessary. Then the good, brave lady held her
poor, dear pet on her lap while the dreadful operation was
performed. She asked a gentleman of the family to hold him, but he
had not the nerve. After the stump had been skilfully dressed, the
little dog evidently felt better, soon ceased to bemoan his loss, and
took kindly to a light supper. He rested well that night, and in the
morning the doctor pronounced him better. His kind mistress nursed
him faithfully till he was restored to perfect health. He never seemed
to fret about his maimed condition, but hopped around on three legs
as merry and active as ever. It was observed, however, that he gave
a wide berth to railway trains, and howled whenever he heard the
whistle of the engine, ever after. Still the fight wasn’t out of him. He
was as jealous of his honor and as fiery and plucky as before his
disaster.
One afternoon, while taking a quiet three-legged stroll some distance
away from home, he encountered on the highway a big, surly bull-
dog, who presumed on the spaniel’s diminutive size and crippled
condition to insult him and rail at him. Brave Fido dashed at once at
the ugly bully’s throat, and bit and hung on in the most furious and
desperate way. It was a gallant fight he made, and it did seem for a
while as though he must come off victorious, like David after his
engagement with Goliah. But at last the infuriated bull-dog tore
himself free, and then proceeded to make mince-meat of the poor
spaniel. He tore his ears half off, and his eyes half out, and mangled
his head generally, till it was disfigured to the last degree. Then he
bit and chewed the left, the only left hind leg, till one might say that
he was next to a locomotive and a whole train of cars at the
mangling business. At this desperate stage of the combat a woman
came out of a farm-house near by, drove the bull-dog away with a
poker, and took up poor Fido. As he had become insensible, she
thought him dead, and flung him down in a fence corner, out of the
way of travel, and there left him, meaning, let us hope, to have him
decently buried in the morning. But Fido was not yet ready to give up
this life. The cool evening dew revived him; brought him to his
senses, in part at least. He could not yet see, but, guided by some
mysterious instinct, he made his sure way, dragging himself by his
fore legs, which were only two you know, across the fields to his
home. His mistress was awakened in the night by hearing him
scratching and whining at the door, and made haste to arise and
take in the poor crippled, blinded, bleeding creature, who laid himself
panting and moaning at her feet. I hope I need not tell you that she
did not give him up. She prepared a soft bed for him in an old
basket, washed and dressed his wounds, and though every body,
especially the doctor, said he must die, that he was as good as dead
then, she was sure she could fetch him round, and she did fetch him
round amazingly.
But alas! Fido’s troubles were not over, even when he got so that he
could hobble about on his three legs, and see tolerably well; for one
cold morning, as he lay curled up in his basket near the kitchen
stove, he was, I grieve to say, terribly scalded by a careless cook,
who spilled a kettle of hot water over him. Even then his mistress
refused to give him up to die, but dressed his burns with sweet oil, or
applied a pain-killer, or “Dalley’s Salve,” and administered Mrs.
Winslow’s Soothing Syrup, perhaps,—anyhow she nursed him so
skilfully and faithfully that she fetched him round again. He is no
beauty nowadays, but alive, and alive like to be. It is my opinion that,
like the great Napoleon, that dog bears a charmed life.
CAT TALES.
FAITHFUL GRIMALKIN.
Many years ago, when my parents lived in old Connecticut, my
mother had a pet cat, a pretty graceful creature, frisky and arch and
gay, though clad in sober gray. She was a favorite with all the large
household, but especially attached herself to my mother, following
her about everywhere,—“up stairs, down stairs, and in my lady’s
chamber,” accompanying her in her walks, hiding behind every bush,
and prancing out upon her in a surprising, not to say startling,
manner.
At last she grew out of kittenhood, laid aside, in a measure, kittenish
things, and became the happiest, fondest, proudest feline mamma
ever beheld. She caressed and gloated over her little, blind, toddling,
mewing, miniature tigers in a perfect ecstasy of maternal delight.
Just at this interesting period of pussy’s life our family moved from
the old place to a house in the country, about a mile away. My
mother was ill, and was carried very carefully on a bed from one
sick-room to another. In the hurry, trouble, and confusion of that time,
poor pussy, who lodged with her family in an attic, was quite
forgotten. But early in the morning of the first day in the new house,
—a pleasant summer morning, when all the doors and windows
were open,—as my mother lay on her bed, in a parlor on the first
floor, she saw her cat walk into the hall and look eagerly around. The
moment the faithful creature caught sight of her beloved mistress,
she came bounding into the room, across it, and on to the bed,
where she purred and mewed in a delighted, yet reproachful way,
quite hysterical, licking my mother’s hand and rubbing up against her
cheek in a manner that said more plainly than words, “Ah! my dear
madam, didst thou think to leave thy faithful Grimalkin behind?
Where thou goest, I will go.”
She was taken into the kitchen and treated to a cup of new milk; but
after a few moments given to rest and refreshment she disappeared.
Yet she went only to come again in the course of an hour, lugging
one of her kittens, which she deposited on the bed, commended to
my mother’s care, and straightway departed. In an almost incredibly
short time she came bounding in with a second kitten. She continued
her journeys till the whole litter had been safely transported, over hill
and dale, ditches and stone-walls, through perils of unfriendly dogs
and mischievous boys, and the family flitting was complete.
After this, our noble puss was loved and respected more than ever.
She dwelt long in the land, and her kits grew up, I believe, to be
worthy of such a mother.
OBEDIENT THOMAS.
Now I want to give you an instance of filial respect and submission
in a young cat. When we first came to Washington, nearly two years
ago, I took to petting a handsome cat belonging to the relatives with
whom we then lived. I fed and caressed her, and she became very
fond of me, always running to meet me when I entered the garden
which she haunted, or the barn in which she lodged. She was rather
wild in her ways, and so stole a nest, in which she finally hid away
some kittens, that she afterwards reared to be wilder than herself.
These somehow disappeared, all but one, which, when he was
about half grown, I undertook to tame. It was a difficult, tedious job;
but I persevered, and at last found him a more affectionate, docile
pet than ever his mother had been. She had seemed fond of him in
his wild, unregenerate days, but as soon as he became
domesticated, and I began to show a partiality for him, she grew very
severe with him, scratching his face and boxing his ears whenever
she saw me caressing him. I soon noticed that when she was near
he was shy, pretending not to be on intimate terms with me; while, if
she was out of the way, I had only to call his name, to have him
come galloping up from the furthest part of the long garden, to rub
against me, to lick my hand, and show every feline fondness and
delight. Now we live at another house, and I seldom see my pets,
mother and son; but they are loving and constant still, proving that
the poet Coleridge didn’t know every thing when he talked about “the
little short memories” of cats.
Master Thomas has grown large and strong, and is accounted a
gallant young fellow by all the young pussies in the neighborhood.
But while toward cats of his own sex he is fierce and combative, he
is just as meek and deferential to his mother as he was in his tender
kittenhood. The other day I encountered him in the old garden, and
was surprised to find how stalwart he had become. I stooped to
caress him, and he seemed as susceptible to gentle overtures as
ever, arched his back, switched his tail, and purred rapturously.
Suddenly the mother cat stole out from behind a tree, and confronted
us. “Good morning, madam,” I said, for I always talk to cats and dogs
just as I talk to other people. “You have a fine son here; a handsome
young fellow, that favors you, I think.” But she wasn’t to be softened
by the compliment. She walked straight up to him, and boxed him
first on one ear and then on the other, quite in the old motherly way.
As for him he never thought of resenting the old lady’s act, or
opposing her will, but drooped his lordly tail, and hastily retreated.
Now that is what I call good family discipline.
This city of Washington is a place where the wits of people are
sharpened, if anywhere, and perhaps even cats and dogs become
uncommonly clever and knowing here. Only yesterday I was told of a
Washington cat which had just been found out in a wonderful trick.
Observing that, when the door-bell rang, the one servant of the
household was obliged to leave the kitchen, she managed to slyly
ring the bell, by jumping up against the wire, and invariably, when
her enemy, the cook, went to the door, she would slip into the
kitchen, and help herself to whatever tempting article of food was
within reach. At last some one watched, and caught her at her secret
“wire-pulling.” Poor puss retired with a drooping tail and a most
dejected aspect, evidently realizing that the game was up.
Another cat I know of was of so amiable and benevolent a
disposition that she actually adopted into her own circle of infant kits
a poor, forlorn little foundling of a rat. As her nursling he grew and
thrived, seeming quite as tame as the others; and when a
mischievous boy set a rat-terrier on him, and so finished him, cat and
kittens really seemed to mourn for their foster son and brother.
KATRINA AND KATINKA.

Once on a time—no matter when—in a certain beautiful city—no
matter where—there lived two lovely twin sisters, with the brightest
eyes, and the cunningest little roly-poly figures, and the slenderest
ears with the softest pink satin lining, and the spryest motions
imaginable. They were brunettes in complexion, with white breasts
and tail-tips, and they were kittens. Katrina and Katinka were their
names, if I remember rightly,—maybe I don’t, but anyhow they might
have had those names, which, to my thinking, are very pretty and
appropriate for kittens.
Well, these same twin pussies were singularly fond of each other,
and more singularly good to each other. They never called names, or
scratched, or spat in each other’s pretty faces, or pulled each other’s
little smellers, or quarrelled over their meals. They were so
marvellously alike that it was always difficult to tell them apart; and
when they slept, as they always did, hugged close in each other’s
arms, you couldn’t have told to save you where one kitten left off and
the other kitten began.
They not only slept, ate, and played together, but, as they grew
older, took their strolls for health and recreation and their mouse-
hunts in the same close and loving companionship. They were very
curious and wide-awake little bodies, and liked to see all they could
of the great, busy world; so every pleasant afternoon, when there
was much driving and walking up and down the fine street on which
they lived, they could be seen strolling down the long walk to the
gate, always exactly side by side,—“neck and neck,” as the horse
people say,—as even in their pace, and as perfectly matched in their
action, as ever were a pair of trained ponies in Hyde Park. Reaching
the gate, they would pause and stand quite still for a half-hour or so,
gravely gazing through the palings at the passers,—pedestrians,
equestrians, and drivers of fast horses,—like a pair of dear little
brigadiers reviewing their brigades marching by. Then, with the air of
having discharged a public duty to the entire satisfaction of the
community, they would wheel exactly together, and again, precisely
neck and neck and tail and tail, trot gently homeward.
So they lived on, in and for each other, almost as much united as if
they had been a pair of small feline female Siamese twins, amiable,
loving, and virtuous, and grew in knowledge and stature up to a
comely young cathood. At last it happened that a very interesting
event occurred to the twin sisters at precisely the same time,—they
became happy mothers, were blessed with three or four fine kittens
apiece. But alas! before the little strangers had got fairly to feel their
legs, before they had got their eyes open, all save one mysteriously
disappeared from each nest. It was one fatal morning when the twin
sisters had slipped out of their happy attic apartment for a little air,—
to take their “Constitutional” in a trot down the long gravel walk to
see how the world would look to them now they were mothers,—that
this kit-napping occurred. When they returned to their families, they
found them strangely thinned out; but they were mothers for all that,
and did not seem to fret much, or abate their maternal pride a jot.
You see the ruling power in the human household in which they were
domesticated, and who was to them as a providence, had ordered a
little hydropathy for their poor, feeble, sprawling, blind darlings,—
beginning with what is called in water-cures “the heroic treatment,” a
cold plunge; and it didn’t agree with them,—it never does with any
but the healthy and hardy patients,—so it was they never came
back. But under the blue waves they sleep well, though never a mew
or a purr comes bubbling up to the surface to tell the spot where they
lie on beds of tangled sea-grass. “Requies-cat in pace,” as old
tombstones say.
The next mournful event in this true family history was the untimely
death of Katrina’s one darling. This had proved to be but a frail
flower of kittenhood; very pretty she was,—“too sweet to live,” people
said. Her constitution was defective, her nervous system was
extremely delicate. Before she was a week old she had something
alarmingly like a fit of catalepsy. Suddenly, while imbibing
nourishment, with her fond mother purring over her, and two or three
children looking on in smiling sympathy, she gave a piteous wild
mew, rolled over on her back, and stuck up her four little legs and
laid out her little tail stiff as a poker! On the ninth day of her little life
she opened her blinking blue eyes on this great wonderful world, in
which she had as good a right to be as you or I; but she didn’t seem
to like the looks of things, for she soon closed those small eyes
again, and never opened them more. Life was evidently too hard a
conundrum for her poor, weak little brain, and she gave it up.
Of course Katrina was greatly afflicted, but she did not abandon
herself utterly to grief. Had not her sister a kitten left? and had not
they two always had every thing in common? So as soon as the
sympathetic children had buried her dead out of her sight under a
lilac-bush, she went straightway to Katinka, and, with her full
consent, began to divide with her the duties and joys of maternity. All
three just cuddled down together in one nest; from mamma or auntie
Master Catkin took nourishment, just as it suited his whim or
convenience, and, as you might suppose, he grew and thrived
astonishingly. So equal and perfect was this partnership in the kitten,
that it was impossible for a stranger to tell which of the two cats was
the real mother. One day all three were brought down to the parlor to
amuse some visitors. Both mammas seemed equally nervous about
having the baby kitten handled, and presently one of them caught it
by the neck,—the cat’s usual, immemorial way of transporting her
young,—and started with it for the attic; when, to the surprise and
immense amusement of all present, the other caught hold of the tail,
and so the two bore it away in triumph.
After this I am afraid the children gave the little kitten rather more
travelling than he liked. It was such fun to see the two anxious cats
following him, mewing, and at the first chance catching him up, and
lugging him home in that absurd manner. Generally the real certain
true mother seized on the head, but sometimes she was
magnanimous enough to yield the post of honor to the aunt, and take
to the tail herself.
So things went on for a few weeks, and then there happened to this
estimable cat-family another sad event,—for this is a tragedy I am
writing, though you may not have suspected it,—Katinka died! What
of has never yet been decided; physicians differed about it, and the
coroner could not make it out. But this much is certain, Katinka died.
The grief of Katrina was and is very affecting to behold. She mopes,
she mews, and her slender tail, which she used to carry erect with
such a jaunty air, droops dolefully. She takes no longer the
“Constitutional” trot down the walk to the front gate. Life seems to
have grown dull and wearisome to her, and the pleasures of mouse-
hunting and tree-climbing appear to have lost their zest. If she
remembers at all the halcyon period when much of her precious time
was spent in a dizzy round of gayety, in a swift pursuit of a ball of
cotton, or a futile pursuit of her own tail, it is in sad wonder that she
could ever have been so merry and thoughtless. She grows thin,
neglects her toilet, and often refuses food; but when the children
offer her catnip, she turns languidly away. If she were acquainted
with Shakespeare, she would doubtless say,—“Canst thou minister
to a mind diseased?” “Throw physic to Bose and Jowler,—I’ll none of
it!”
Friendly cat-neighbors call in occasionally, but they cannot console
her. All the petting of the household fails thus far to make her cheery
and playful as once she was. She is fed on the very “milk of human
kindness,” but grief has licked the cream off.
She seems to find her only consolation in her care and affection for
the motherless catkin, and in his fondness for her. I am sorry to say
that he does not show a very deep sense of his loss; perhaps he is
too young to realize it. His good aunt seems sufficient for all his
needs, and he thrives finely, is fat and jolly, and full of all kittenish
pranks and mischievous tricks. Poor Katrina will have a time with
him, I fear, as he is sadly petted and indulged. Such a lazy rascal as
he is too,—don’t earn the salt of his porridge, that is, if he took it
salted,—and, though quite old enough to “go on the war path,” has
never yet killed his mouse, or brought home a rat’s scalp, or a
ground-squirrel’s brush, or as much as a feather from a tomtit’s wing.
Ah! of all the darlings in the world, an aunty’s darling is the likeliest to
be spoiled.
This is all I know about this curious cat-family. I hope, dear children,
that my true story may not sadden you, for I really wish you, one and
all, the merriest of merry Christmases, and the happiest of happy
New Years.
All I can say in the way of a moral to my little story is: How beautiful
is love! even when shown in the fortunes and sorrows of cats and
kittens, how beautiful is love!
FEATHERED PETS.
OUR COUSINS THE PARROTS.

These strangely interesting birds, according to natural history,
belong to the second bird family, the Psittacidæ. I never knew how
many wonderful and splendid varieties this family contained until I
saw living varieties of all, or nearly all, in the known world, in the
Zoölogical Gardens of London, where they are kept in a great
gallery,—a beautiful parrot paradise, all by themselves. They were a
wonder to behold, but a perfect astonishment to listen to. The
confusion of tongues was something almost distracting. The Tower
of Babel, in its talkingest day, never approached it, I am sure. A large
sewing-circle of elderly ladies might come nearer the mark. The
colors of their plumage I have no words to describe. They fill my
memory with tropic splendors whenever I think of them, to this day.
’Tis strange that but one species of parrots was known to the ancient
Greeks and Romans,—the Parakeet of India,—at least up to the time
of Nero. That gentle prince, with his amiable love of pets, is said to
have sent emissaries far up the Nile to collect new varieties for the
gratification of his royal whim and dainty appetite; for, when the poor
little captives ceased to amuse him by their conversational powers,
he ate them. I hope they lay hard on his stomach, and made him talk
in his sleep!
The early Portuguese navigators found parrots at the Cape of Good
Hope, and at other points on the African coast; and the very first
creatures that welcomed Columbus to the isles of the New World
were Parakeets. The Macaws of South America are very handsome
birds, but not remarkably tractable or agreeable. They are fond of old
friends, but are fierce to strangers, and have a singular dislike to
children. The gray and scarlet parrot, called the Yaco, is a charming
bird for a pet. It is clever and docile, and learns readily to talk,
preferring to imitate the voices of children. The Cockatoos of New
Guinea are very pretty and graceful pets. They do not like to be
caged, but may be safely allowed to have the range of the premises,
as they will immediately come when called; thus setting an excellent
example to rebellious children. The green parrot, most common in
this country, is a native of Africa.
Dear old Dr. Goldsmith, whose Natural History is all out of fashion
now, except with us old folks, tells some amusing stories about
parrots. Among these is an anecdote of a famous fellow, belonging
to King Henry the Seventh, Queen Elizabeth’s grandfather. This bird,
sitting on his perch in the palace-yard at Westminster, used to hear
the talk of gentlemen who came to the river to take boats. And one
day, while overlooking the busy traffic of the Thames, he fell from a
tree into the water; and while there, floating helplessly, he cried: “A
boat! twenty pounds for a boat!” A waterman rescued him, and took
him to the king, demanding his twenty pounds. The king, who was
not remarkably generous, hesitated about giving so large a sum; but
finally agreed to leave the amount of the reward to the parrot. That
ungrateful fellow, who sat on his perch, still shaking the water from
his feathers, when appealed to, turned his head slyly on one side,
and said, “Give the knave a groat” (about fourpence). I hope,
children, you won’t doubt the truth of this story; it isn’t good to get
into sceptical habits of mind in early life.
For many years there lived in the porter’s lodge of the old
Pennsylvania Hospital a distinguished and venerable citizen,—a
parrot of rare cleverness and intelligence. This famous bird belonged
to the porter, and was one of many feathered pets, the chief favorite
and familiar. A remarkable affection and sympathy existed between
these two friends; yet I am sorry to say their relations were not
altogether pleasant and peaceful. Innumerable were their quarrels
and make-ups. The bird was very knowing, and almost
supernaturally gifted as a talker, especially, like some human orators,
in the language of railing and taunting. The old man, his master, had
one deplorable weakness,—he would occasionally drink too much
whiskey; so much that, getting quite beside himself, he would leave
his lodge and his innocent feathered family, and go off on a
desperate spree, which sometimes lasted for days. Now, Master
Paul Parrot thought this weakness, through which he suffered in
loneliness and neglect, very reprehensible and not to be winked at,
and when the fit of dissipation was coming on his master, it is said,
would remonstrate with him, in a friendly way, like a very Mentor.
When this proved in vain, and he saw the misguided old man leave
the lodge for some of his disreputable haunts, he would endeavor to
put a good face on the matter, would hop about on his perch in great
excitement, and call out to the other birds: “The old man has gone on
a spree!—on a spree! He won’t be back for a week! Let’s have a
time. Ha, ha!”
When the old porter came home, this naughty bird would be very apt
to mock and taunt him, calling out: “So you’ve come back,—have
you? O, how drunk you are! Now we’ll have a row.” And there always
was a row; for the indignant porter never failed to beat Mr. Paul, for
his impudence, soundly. Then the bird, seeking the dignified
retirement of the darkest corner of the lodge, sulked and muttered,
till, the old porter’s good-humor returning, he made friendly
overtures. The two were reconciled, and “every thing was lovely”
again.
At length the poor old porter died; and as his successor was no bird-
fancier the feathered family at the lodge was broken up and
dispersed. The clever parrot was kindly treated in a new home; but
he never seemed happy. He evidently missed his old master,—
missed his caresses and his scoldings. Or perhaps he found the
steady goings-on of a moral household too dull for his taste, for
when I went to see him, I found him as glum, stupid, and morose as
an old politician who had had his day. All he would say was, “O you
goose!”
There is another curious parrot in Philadelphia, in a store kept by a
maiden lady whose voice is so exceeding shrill and parrot-like that it
is difficult to tell when she leaves off talking and the parrot begins.
One day, as a customer was examining an article on the counter,
Miss Polly called out: “What are you doing with that? Put it down! put
it down!” The lady looked round very indignantly for the offender,
saying: “Well, ma’am, I must say you have a very impudent child.”
There is in the same city another parrot, who recites a verse of an
old song in a most distinct and triumphant manner:—
“O pretty Polly,
Don’t you cry,
For your true-love
Will come by and by.”
There is in Brooklyn, New York, a parrot that sings many of the
popular airs correctly, and with as much expression as many
fashionable singers give to them. This bird is singularly social and
affectionate, and has a horror of being alone. He will sometimes
awake in the middle of the night, and arouse the household by
crying: “O dear! I am all alone!—all alone! Somebody come to me!”
I have heard much of a clever parrot once kept by some relatives of
ours on an old place in a quiet little village. Mistress Polly had free
range of the house and yard, and throughout the town was as well
known as the oldest inhabitant. Through all the pleasant weather she
haunted the tall trees in front of the house, climbing to the highest
branches, and from there superintending the affairs of the
neighborhood, and making astronomical and meteorological
observations. In the spring and autumn she watched from these lofty
perches the flight of great flocks of pigeons and crows with intense
but decidedly unfriendly interest. She would scream and scold at
them in a most insolent and defiant manner, evidently criticising the
order of their march and all their manœuvres and evolutions, for all
the world like a newspaper editor finding fault with the conduct of
great armies. Doubtless she was astonished and disgusted to see
the great host sweep steadily on, following their leader, paying no
heed to her shrieking, railing, and evil prophecies. Yet she was never
so absorbed by her duties on the watch-tower that she failed to
come to her meals. These she took with the family, perched on the
back of a chair or the corner of the table. She was very fond of
coffee, and was always provided with a cup. She would take it up by
the handle with her claws, and drink from it without spilling a drop. A

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DHO Health Science Updated 8th

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Notice to the Reader

Printed in the United States of America

Part 1 Basic Health Care Concepts and Skills 2

CHAPTER 2 Health Care Systems 30

CHAPTER 3 Careers in Health Care 43

CHAPTER 4 Personal and Professional Qualities

CHAPTER 5 Legal and Ethical Responsibilities 106

CHAPTER 6 Medical Terminology 123

CHAPTER 7 Anatomy and Physiology 145

CHAPTER 8 Human Growth and Development 240

CHAPTER 9 Cultural Diversity 262

CHAPTER 10 Geriatric Care 279

CHAPTER 11 Nutrition and Diets 297

CHAPTER 12 Computers and Technology in Health Care 316

CHAPTER 13 Medical Math 338

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

CHAPTER 4 Personal and Professional Qualities

Appendix A: Career and Technical Student Glossary984

Foundation Standards. Health Insurance Portability

• Mandates of the Health Insurance Portability and and Accountability Act