PREFACE
Medical assisting as a profession has changed dramatically since 1he Office Assistant in Medical and Dental Practice, by Portia Frederick and Carol Towner, was first published in 1956. Each subsequent edition of this textbook has reflected the age in which it was published. Now, Kinn's 1he Medical Assistant: An Applied Learning Approach, thirteenth edition, in its 60th year of publication, continues to represent a long-standing commitment to high-quality medical assisting education with its engaging, straightforward writing style and demonstrated positive outcomes. Hundreds of instructors in classrooms across the country have used this text to teach thousands of students over the years. Many of these students have gone on to teach students of their own with this very same trusted resource. To continue the use and growth of this text and its features, the thirteenth edition continues to offer the most comprehensive, up-to-date, and innovative approach to teaching this subject today.
This textbook has endured throughout the years because it has been able to keep pace with an ever-changing profession while producing students who are well trained and qualified to enter medical practices across the country. This dependability is the reason the market continues to rely on this text, edition after edition. Underlying this dependability is a foundation of pedagogic features that has stood the test of time and that has been expanded and improved upon yet again in this latest edition. Such features include the following:
• An easy-to-read, highly interactive writing style that engages students through practical applications of medical assistant competencies.
• An emphasis on skill development, with procedural steps outlining each skill, supported by rationales that provide meaning to each step.
• A pedagogic framework based on the use of learning objectives, vocabulary terms, and supportive student supplements.
• A package of supportive materials to accommodate a wide variety of student learning types and instructor teaching styles.
NEWTOTHISEDITION
• Updated Art Program. The artwork throughout has been updated and modernized, providing a more attractive textbook for student use. Many new photographs and line drawings throughout support the revised content more effectively and are more relevant to the actual healthcare setting. New images show up-to-date equipment, provide more disease examples, and better illustrate key procedural steps.
• New chapter on Competency-Based Education for Medical Assisting. The emphasis of competency mastery is high to meet accreditation standards. This chapter helps set the stage for medical assisting students to understand their programming and how the road to mastery will affect their ability to attain a job.
• New Chapter on The Health Record. The manner in which the medical record is maintained in a medical office has changed dramatically with the move to the EHR. This chapter reviews how the medical assistant maintains and interacts with the medical record.
• Learning Objectives are listed in the same order as the flow of content. The learning objectives are tied to curriculum competencies. This feature makes it easy to see where the learning objectives are covered to aid in review of the material and measurement of competency coverage.
• Procedures are integrated into the TOC. Provides a quick reference to where the procedures will be covered and in what order.
• Professional Behaviors boxes. The medical assistant must develop the ability to interact professionally with patients, families, co-workers, and other members of the healthcare team. These boxes provide tips on professional behavior that are specific to each chapter's content.
EVOLVE
The Evolve site features a variety of student resources, including Chapter Review Quizzes, new Procedure Videos, Medical Terminology Audio Glossary, practice CMA and RMA exams, and much more! The instructors' Evolve Resources site consists of TEACH Instructor Resources, including Lesson Plans, PowerPoint Presentations, Answer Keys for Chapter Review Quizzes, and a retooled Test Bank with more than 3000 questions.
STUDYGUIDEANDPROCEDURE CHECKLISTMANUAL
The Study Guide provides students with the opportunity to review and build on information they have learned in the text through vocabulary reviews, case studies, workplace applications, and more. The updated Procedure Checklists include CAAHEP and ABHES competencies that can be traced to the online correlation grid.
fEAlURES
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NTRODUCTION TO MEDICAL ASSISTING
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UNITONE
NEW! Professional Behaviors boxes provide tips on professional behavior that are specific to each chapter's content.
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112UNITTWO
CONTENTS
UNITONE
IntroductiontoMedicalAssisting
DeborahProctor
1Competency-BasedEducationandtheMedical AssistantStudent,1
Adult Learners and Competency-Based Education, 2
Portfolios, 2
Who You are as a Learner: How Do You Learn Best?, 3
Coping Mechanisms, 5
Time Management: Putting Time on Your Side, 6
Study Skills: Tricks for Becoming a Successful Student, 7
Test-Taking Strategies: Taking Charge of Your Success, 9
Becoming a Critical Thinker: Making Mental Connections, 1O
Problem Solving and Conflict Management, 11
Assertive, Aggressive, and Passive Communication, 12
2TheHealthRecord,15
Types of Records, 17
The Importance of Accurate Health Records, 17
Contents of the Health Record, 17
Procedure2-1:CreateaPatient'sHealthRecord: RegisteraNewPatientinthePractice ManagementSoftware,20
Ownership of the Health Record, 22
Technologic Terms in Health Information, 22
American Recovery and Reinvestment Act, 23
The Health Information Technology for Economic and Clinical Health Act and Meaningful Use, 23
Advantages and Disadvantages of the EHR, 23
Procedure2-2:OrganizeaPatient'sHealthRecord: UploadDocumentstotheElectronicHealth Record,27
Nonverbal Communication with the Patient When Using the Electronic Health Record, 27
Backup Systems for the Electronic Health Record, 28
Releasing Health Record Information, 29
Creating an Efficient Paper Health Records Management System, 31
Documenting in an Electronic Health Record, 31
Documenting in a Paper Health Record, 31
Making Corrections and Alterations to Health Records, 33
Dictation and Transcription, 33
Filing Equipment, 35
Filing Supplies, 36
Procedure2-3:CreateandOrganizeaPatient'sPaper HealthRecord,38
Filing Methods, 39
Procedure2-4:FilePatientHealthRecords,39
Organization of Files, 40 Closing Comments, 41
3InfectionControl,45
Disease, 46
The Chain of Infection, 47
The Inflammatory Response, 49
Types of Infections, 50
OSHA Standards for the Healthcare Setting, 51
Procedure3-1:ParticipateinBloodbornePathogen Training:UseStandardPrecautionstoRemove ContaminatedGlovesandDiscardBiohazardous Material,54
Procedure3-2:DemonstratetheProperUseofEye WashEquipment:PerformanEmergencyEye Wash,56
Procedure3-3:ParticipateinBloodbornePathogen TrainingandaMockEnvironmentalExposure EventwithDocumentationofSteps,59
Aseptic Techniques: Preventing Disease Transmission, 60
Procedure3-4:ParticipateinBloodbornePathogen Training:PerformMedicalAsepticHand Washing,62
Procedure3-5:SelectAppropriateBarrier/Personal ProtectiveEquipmentandDemonstrateProper DisposalofBiohazardousMaterial:UseStandard PrecautionsforSanitizingInstrumentsand DiscardingBiohazardousMaterial,64
Role of the Medical Assistant in Asepsis, 65
Closing Comments, 65
Procedure3-6:PerformComplianceReportingBased onPublicHealthStatutes,67
4PatientAssessment,69
Medical History, 70
Understanding and Communicating with Patients, 71
Procedure4-1:DemonstrateTherapeutic CommunicationFeedbackTechniquestoObtain PatientInformationandDocumentPatientCare AccuratelyintheMedicalRecord,74
Procedure4-2:RespondtoNonverbal Communication,79
Interviewing the Patient, 79
Assessing the Patient, 83 Documentation, 84
Procedure4-3:UseMedicalTerminologyCorrectly andPronounceAccuratelytoCommunicate InformationtoProvidersandPatients,90 Closing Comments, 93
11AdministeringMedications,241
Safety in Drug Administration, 242
Drug Forms and Administration, 245
Procedure11-1:AdministerOralMedications,248
Procedure11-2:FillaSyringefroman Ampule,251
Procedure11-3:FillaSyringefromaVial,252
Procedure11-4:ReconstituteaPowderedDrugfor Administration,259
Procedure11-5:AdministerParenteral(ExcludingIV) Medications:GiveanlntradermalInjection,260
Procedure11-6:SelecttheProperSitesfor AdministeringaParenteralMedication:Administer aSubcutaneousInjection,264
Procedure11-7:MixTwoDifferentTypesofInsulinin OneSyringe,266
Procedure11-8:AdministerParenteral(ExcludingIV) Medications:AdministeranIntramuscularInjection intotheDeltoidMuscle,270
Procedure11-9:SelecttheProperSitesfor AdministeringaParenteralMedication:Administer aPediatricIntramuscularVastusLafera/is Injection,272
Procedure11-10:AdministerParenteral (ExcludingIV)Medications:GiveaZ-Track IntramuscularInjectionintotheDorsogluteal Site,275
Closing Comments, 276
Procedure11-11:CompleteanIncidentReport RelatedtoanErrorinPatientCare,278
UNITTHREE
AssistingwithMedicalSpecialties
DeborahProctor
12SafetyandEmergencyPractices,282
Safety in the Healthcare Facility, 283
Procedure12-1:EvaluatetheWorkEnvironmentto IdentifyUnsafeWorkingConditionsandComply WithSafetySignsandSymbols,285
Procedure12-2:ManageaDifficultPatient,286
Procedure12-3:DemonstratetheProperUseofa FireExtinguisher,287
Procedure12-4:ParticipateinaMock EnvironmentalExposureEvent:Evacuatea Provider'sOffice,288
Disposal of Hazardous Waste , 289 Emergency Preparedness, 289
Procedure12-5:MaintainanUp-to-DateListof CommunityResourcesforEmergency Preparedness,291
Assisting with Medical Emergencies, 291
Procedure12-6:MaintainProvider/Professional-Level CPRCertification:UseanAutomatedExternal Defibrillator (AED), 294
General Rules for Emergencies, 294
Procedure12-7:PerformPatientScreeningUsing EstablishedProtocols:TelephoneScreeningand AppropriateDocumentation,295
Procedure12-8:MaintainProvider/Professional-Level CPRCertification:PerformAdultRescueBreathing andOne-RescuerCPR;PerformPediatricand InfantCPR,298
Procedure12-9:PerformFirstAidProcedures: AdministerOxygen,301
Procedure12-10:PerformFirstAidProcedures: RespondtoanAirwayObstructionin anAdult,302
Procedure12-11:PerformFirstAidProcedures: CareforaPatientWhoHasFaintedorIs inShock,305
Common Office Emergencies, 306
Procedure12-12:PerformFirstAidProcedures:Care foraPatientWithSeizureActivity,309
Procedure12-13:PerformFirstAidProcedures:Care foraPatientWithaSuspectedFractureofthe WristbyApplyingaSplint,310
Procedure12-14:PerformFirstAidProcedures: ControlBleeding,312
Procedure12-15:PerformFirstAidProcedures:Care foraPatientWithaDiabeticEmergency,314 Closing Comments, 315
13AssistinginOphthalmologyandOtolaryngology,319
Examination of the Eye, 320
Procedure13-1:PerformPatientScreeningUsing EstablishedProtocols:MeasureDistanceVisual AcuitywiththeSnellenChart,328
Procedure13-2:InstructandPrepareaPatientfora Procedure:AssessColorAcuityUsingtheIshihara Test,330
Procedure13-3:InstructandPrepareaPatientfor aProcedureorTreatment:IrrigateaPatient's Eyes,332
Procedure13-4:InstructandPrepareaPatientfor aProcedureorTreatment:InstillanEye Medication,333
Examination of the Ear, 335
Procedure13-5:PerformPatientScreeningUsing EstablishedProtocols:MeasureHearingAcuity withanAudiometer,341
Procedure13-6:InstructandPrepareaPatient foraProcedureorTreatment:IrrigateaPatient's Ear,342
Procedure13-7:InstructandPrepareaPatientfora ProcedureorTreatment:InstillMedicatedEar Drops,344
Examination of the Nose and Throat, 345
Procedure13-8:PerformPatientScreeningUsing EstablishedProtocols:CollectaSpecimenfora ThroatCulture,346 Closing Comments, 347
14AssistinginDermatology,350
Anatomy and Physiology, 351 Diseases and Disorders, 352 Dermatologic Procedures, 364
Closing Comments, 366
15AssistinginGastroenterology,368
Anatomy and Physiology, 369
Diseases of the Gastrointestinal System, 370 Characteristics of the GI System, 371
Procedure15-1:PerformPatientScreeningUsing EstablishedProtocols:TelephoneScreeningofa PatientwithaGastrointestinalComplaint,373
Diseases of the Liver and Gallbladder, 380
The Medical Assistant's Role in the Gastrointestinal Examination, 383
Procedure15-2:AssisttheProviderwithaPatient Examination:AssistwithanEndoscopic ExaminationoftheColon,386
Procedure15-3:InstructandPrepareaPatientfora Procedure:InstructPatientsintheCollectionofa FecalSpecimen,387
Closing Comments, 388
16AssistinginUrologyandMaleReproduction,391
Anatomy and Physiology of the Urinary System, 392 Disorders of the Urinary System, 393
Pediatric Urologic Disorders, 400
Anatomy and Physiology of the Male Reproductive System, 401
Disorders of the Male Reproductive Tract, 402
Procedure16-1:CoachPatientsinHealth Maintenance:TeachTesticular Self-Examination,406
The Medical Assistant's Role in Urologic and Male Reproductive Examinations, 410 Closing Comments, 411
17AssistinginObstetricsandGynecology,414
Anatomy and Physiology, 415 Contraception, 417
Gynecologic Diseases and Disorders, 420
Procedure17-1:InstructandPrepareaPatientfor Proceduresand/orTreatments:Assistwiththe ExaminationofaFemalePatientandObtaina SmearforaPapTest,426
Procedure17-2:InstructandPrepareaPatientfor Proceduresand/orTreatments:PreparethePatient foraLEEP,429
Procedure17-3:CoachPatientsinHealth MaintenanceandDiseasePrevention:Teachthe PatientBreastSelf-Examination,432 Pregnancy, 434
Menopause, 437
The Medical Assistant's Role in Gynecologic and Obstetric Procedures, 438
Procedure17-4:InstructandPrepareaPatientfor Proceduresand/orTreatments:Assistwitha PrenatalExamination,439
Diagnostic Testing, 441
Closing Comments, 442
18AssistinginPediatrics,446
Normal Growth and Development, 447
Pediatric Diseases and Disorders, 452
Immunizations, 462
Procedure18-1:VerifytheRulesofMedication Administration:DocumentImmunizations,466
The Pediatric Patient, 469
The Medical Assistant's Role in Pediatric Procedures, 470 Procedure18-2:MaintainGrowthCharts:Measure theCircumferenceofanInfant'sHead,472
Procedure18-3:MaintainGrowthCharts:Measurean Infant'sLengthandWeight,473
Procedure18-4:MeasureandRecordVitalSigns: ObtainPediatricVitalSignsandPerformVision Screening,476
Procedure18-5:AssistProviderWithaPatientExam: ApplyingaUrinaryCollectionDevice,479
The Adolescent Patient, 480 Injury Prevention, 480 Child Abuse, 480
Closing Comments, 481
19AssistinginOrthopedicMedicine,484
Anatomy and Physiology of the Musculoskeletal System, 485 Musculoskeletal Diseases and Disorders, 490
The Medical Assistant's Role in Assisting with Orthopedic Procedures, 502
Specialized Diagnostic Procedures in Orthopedics, 502
Radiology, 503
Therapeutic Modalities, 504
Procedure19-1:AssisttheProviderwithPatientCare: AssistwithColdApplication,505
Procedure19-2:AssisttheProviderwithPatientCare: AssistwithMoistHeatApplication,506 Ambulatory Devices, 507
Procedure19-3:CoachPatientsintheTreatment Plan:TeachthePatientCrutchWalkingandthe Swing-ThroughGait,509
Management of Fractures, 511
Procedure19-4:AssisttheProviderwithPatientCare: AssistwithApplicationofaCast,511
Procedure19-5:AssisttheProviderwithPatientCare: AssistwithCastRemoval,513
Closing Comments, 514
20AssistinginNeurologyandMentalHealth,517
Anatomy and Physiology of the Nervous System, 518 Diseases and Disorders of the Central Nervous System, 522
Diseases of the Peripheral Nervous System, 531
The Medical Assistant's Role in the Neurologic Examination, 533
Procedure20-1:AssisttheProviderwithPatientCare: AssistwiththeNeurologicExamination,535 Diagnostic Testing, 535
Classifications of Surgical Instruments, 829
Specialty Instruments, 834
Care and Handling of Instruments, 836
Drapes, Sutures, and Needles, 837
Closing Comments, 840
33SurgicalAsepsisandAssistingWithSurgical Procedures,842
Sterilization, 843
Procedure33-1:PrepareItemstorAutoclaving:Wrap InstrumentsandSuppliestorSterilizationinan Autoclave,846
Procedure33-2:PerformSterilizationProcedures: OperatetheAutoclave,849
Surgical Procedures, 850
Assisting with Surgical Procedures, 852
Procedure33-3:PerformSkinPreptor Surgery,853
Procedure33-4:PerformHandwashing:Performa SurgicalHandScrub,855
Procedure33-5:PrepareaSterileField,858
Procedure33-6:PerformWithinaSterileField:Use TransferForceps,859
Procedure33-7:PerformWithinaSterileField:Pour aSterileSolutionintoaSterileField,860
Procedure33-8:PerformWithinaSterileField:Put onSterileGloves,860
Procedure33-9:PerformWithinaSterileField:Assist withMinorSurgery,864
Procedure33-10:PerformWoundCare:Assist WithSuturing,867
Procedure33-11:PerformWoundCareanda DressingChange:ApplyorChangeaSterile Dressing,868
Procedure33-12:PerformWoundCare:Remove Suturesand/orSurgicalStaples,870
Wound Care, 871
Procedure33-13:PerformWoundCare:Applyan ElasticSupportBandageUsingaSpiralTurn,876 Closing Comments, 877
UNITSIX
CareerDevelopment BrigitteNiedzwieckiandJuliePepper
34CareerDevelopmentandLifeSkills,881 Moving on to the Next Phase of Life, 882 Understanding Personality Traits Important to Employers, 882
Developing Career Objectives, 884 Knowing Personal Needs, 884 Finding a Job, 885 Developing a Resume, 887
Procedure34-1:PrepareaChronologicResume,887 Developing a Cover Letter, 893
Procedure34-2:CreateaCoverLetter,895 Completing Online Profiles and Job Applications, 895
Procedure34-3:CompleteaJobApplication,897 Creating a Career Portfolio, 897
Procedure34-4:CreateaCareerPortfolio,898 Job Interview, 898
Procedure34-5:PracticeInterviewSkillsDuringa MockInterview,902
Procedure34-6:CreateaThank-YouNotetoran Interview,902
You Got the Job!, 903 Life Skills, 905 Closing Comments, 907 Glossary,91O Index,927
For many years the curriculum for medical assistant programs has been based on student achievement of specific competencies . According to the Medical Assisting Education Review Board (MAERB):
Medical assistants graduating from programs accredited by the Commission on Accreditation of Allied Health Education Programs (CAAHEP) will demonstrate critical thinking based on knowledge of academic subject matter required for competence in the profession. They will incorporate the cognitive knowledge in performance of the psychomotor and affective domains in their practice as medical assistants in providing patient care.
The Accrediting Bureau of Health Education Schools (ABHES) also bases its recommended curriculum on student achievement of identified competencies:
The depth and breadth of the program's curriculum enables graduates to acquire the knowledge and competencies necessary to become an entry-level professional in the medical assisting field. Competencies required for successful completion of the program are delineated, and the curriculum ensures achievement of these entry-level competencies through mastery of coursework and skill achievement. Focus is placed on credentialing requirements and opportunities to obtain employment and to increase employability.
National curriculum standards for the education of medical assistants are based on recognized competencies that employers expect entry-level medical assistants to have. The 2015 Core Curriculum for Medical Assistants established by the MAERB must be followed for programs accredited by CAAHEP. Those completing a CAAHEPaccredited program must demonstrate core entry-level competencies in knowledge of subject matter, be able to perform the psychomotor skills needed in an ambulatory care center, and have appropriate behavioral competencies to respond professionally and with empathy toward patients and their families. The 12 academic subjects in a CMHEP-approved curriculum are as follows:
I. Anatomy and Physiology
II. Applied Mathematics
III. Infection Control
IV Nutrition
V Concepts of Effective Communication
VI. Administrative Functions
VII. Basic Practice Finances
VIII. Third Party Reimbursement
IX. Procedural and Diagnostic Coding
X. Legal Implications
XI. Ethical Considerations
XII. Protective Practices
ABHES also offers accreditation for medical assisting programs. The organization focuses its curriculum requirements on student competency achievement with 11 required areas of study:
1. General Orientation [to the field of medical assisting]
2. Anatomy and Physiology
3. Medical Terminology
4. Medical Law and Ethics
5. Psychology of Human Relations
6. Pharmacology
7. Records Management
8. Administrative Procedures
9. Clinical Procedures
10. Medical Laboratory Procedures
11. Career Development
What does this mean for you, the medical assistant student? To meet national standards, your MA program must comply with competency-based learning in multiple areas. The most important characteristic of competency-based education is that it measures learning and skill achievement over time. Students progress through the program by demonstrating their competence, which means they prove they have mastered the knowledge, skills, and professional behaviors required to achieve competency in a particular task. For example, one of the basic skills you must achieve as a medical assistant student is taking an accurate blood pressure. Some students will have more difficulty consistently achieving this goal than others, but each student must be able to take a blood pressure accurately before he or she can move on in the curriculum.
ADULTLEARNERSAND COMPETENCY-BASEDEDUCATION
Competency-based learning is ideal for adult learners who are attempting to understand new information and achieve new skills. Educators recognize that adult learners come to the classroom with different work-related experiences and educational backgrounds. Therefore, adult students have a wide range of understanding about the knowledge and skills that must be achieved in the program. Adult students also learn material at different rates. Competencybased education recognizes these qualities of adult learners and takes advantage of them. Let's go back to the blood pressure example. Perhaps you took a healthcare lab in high school, in which you learned to take blood pressures; another student may have worked in a long-term care facility, where he was responsible for monitoring vital signs throughout the day. You both may need just a review of the anatomy and physiology aspects of a patient's blood pressure. However, other students in the class will not know anything about this skill. With competency-based education, your instructor can design laboratory activities that meet all students' needs, including your own.
CRITICALTHINKING APPLICATION 1-1
Can you think of any examples of how competency-based education might help you succeed as a medical assistant student? Come up with two possibilities and share them with your classmates.
PORTFOLIOS
Have you taken a class in the past that required you to develop a portfolio? Portfolios are frequently used in an Art or English class to demonstrate student skills and learning achievements. Generally, a portfolio is a collection of student materials that demonstrates learning. An advantage of developing a portfolio for a medical assistant program is that you can decide which pieces of your work best demonstrate your learning and skill achievement over time. Why would this be beneficial to you?
In a competency-based program, you must achieve a series of skills, not only to complete the program, but also to prove to future
