Health Care Systems & Settings

Module 1: Health Care Systems & Settings

• A primary care provider is the first provider a patient seeks care from.
• The main goal of a PCP is to coordinate preventative healthcare services.
• Family practitioners, internal medicine physicians, Doctors of Osteopathic Medicine (DO), and pediatricians can all be PCPs.
• Medical doctors are considered allopathic providers and are the most recognized.
• Medical doctors use medicine and surgical procedures to treat.
• Osteopathic providers are DOs who use osteopathic manipulative therapy in addition to medicine and surgery.
• Advanced practice nurses include clinical nurse specialists, nurse anesthetists, nurse practitioners (NP), and nurse midwives.
• Nurse practitioners provide patient care services.
• They can diagnose and prescribe medications for common illnesses.
• NPs focus on preventative care and prevention.
• Nurse practitioners are more advanced than registered nurses and can perform the same tasks as a physician assistant.
• Registered nurses have a nursing degree and are licensed by individual states.
• RNs see case management of patients who have complex chronic conditions.
• They also coach patients about their overall health.
• Practical nurses are vocational nurses.
• They usually train for one year at a community college.
• Practical nurses triage phone calls, administer medications, and perform other clinical duties.
• Registered dietitian nutritionists are experts in diet and nutrition.
• There is a connection between registered dietitians and chronic conditions.
• Support staff includes clinic coordinators, medical administrative assistants, clinical medical assistants, medical records specialists, medical billing specialists, financial counselors, and schedulers.
• Physician assistants practice under a medical doctor or Doctor of Osteopathic Medicine.
• They are able to make clinical decisions.
• Recommended personal space is 1½ to 4 ft.
• Allied health professionals include medical laboratory technicians, medical receptionists, occupational therapists, pharmacy technicians, physical therapists, and radiology technicians.
• Medical laboratory technicians do diagnostic testing on blood, bodily fluids, and other specimens under a medical technologist’s supervision.
• Medical receptionists check patients in and out, answer phones, schedule appointments, and perform administrative tasks.
• Occupational therapists assist patients who have conditions that disable them developmentally, emotionally, mentally, or physically.
• Pharmacy technicians perform routine medication dispensing functions that do not require a licensed pharmacist’s expertise or judgment, under the direct supervision of a pharmacist.
• Physical therapists assist patients in improving mobility, strength, and range of motion.
• Radiology technicians use imaging equipment to assist the provider in diagnosing and treating certain diseases.
• First, a medical doctor goes to an institute and gets a degree to obtain licensure.
• Licensure also requires a state exam.
• Reciprocity and endorsement are two other licensure options.
• Reciprocity licensure recognizes that the requirements were met from another state, automatically recognizing those requirements.
• Endorsement licensure is granted to graduates of U.S. medical schools and is based on case-by-case examinations.
• No state requires medical assistants to be licensed.
• Certification is optional but may be needed to administer medication or perform phlebotomy procedures.
• It is required for medical assistants to enter prescriptions into the Computerized Provider Order Entry (CPOE) program.
• Certification advantages include higher wages, more jobs, and career advancement.
• A CPOE program is a computerized physician order entry system.
• Health care delivery is also known as the health care system.
• It involves the organization of individuals, establishments, and resources to deliver health care services and meet the health needs of specific populations.
• The payment model issues a single bundled payment to providers or health care facilities for all services rendered to treat a given condition or provide a given treatment.
• The Affordable Care Act (ACA) promoted newer health care systems and payment models by testing new methods of health care delivery and moving from a reimbursement structure, which is based on the amount of services rendered.
• The ACA emphasizes the need for team-based medicine.
• The three main goals of the ACA include expanding health insurance coverage, shifting the focus of the health care delivery system from treatment to prevention, and reducing costs and improving the efficiency of health care.
• Health care models include accountable care organizations, capitation, global budgets, health maintenance organizations, patient-centered medical homes, pay for performance, and preferred provider organizations.
• Accountable care organizations are groups of physicians, hospitals, ambulatory care, and other health care providers that voluntarily provide coordinated high-quality care to Medicare patients.
• ACO’s focus is on care coordination but with many practices within one organizing entity.
• They focus on the patient in one organization and emphasize public health issues to prevent illness.
• ACO's have outreach programs such as smoking cessation and weight loss clinics.
• Partial or full capitation assigns patients a per-member, per-month payment based on age, race, sex, lifestyle, medical history, and benefit design.
• Payment ratings are tied to expected usage regardless of how often the patient visits but minimize high cost procedures and tests.
• A global budget is a fixed amount paid annually for care, but providers determine how the money is spent.
• It limits the level and rate of increase of health care costs.
• Health maintenance organizations contract with a medical center or providers to provide preventative and acute care for insured persons but require referrals to specialists and are more comprehensive.
• A patient-centered medical home is where a PCP coordinates treatment to ensure patients receive the required care when and where they need it and in a way they can understand.
• The goal of a PCMH includes having a centralized setting that facilitates partnership between the patient, provider, and patient’s family.
• Five core attributes of the PCMH are comprehensive care, patient-centeredness, coordinated care, accessible services, quality and safety.
• Comprehensive care means caring for all patients’ needs by focusing on the whole patient, not just medical and physical concerns.
• Patient-centeredness means positioning patients and their families as core members of the team.
• Coordinated care means overseeing all specialty care and hospitals by the provider-directed medical practice.
• Accessible services include providing tools such as open scheduling through patient information web portals.
• Delivering quality health care ensures quality and safety.
• Pay for performance compensates providers only if they meet certain measures for quality and efficiency.
• Preferred provider organizations are more flexible than HMOs.
• With a PPO, the insured person doesn't need a PCP but can go to a specialist without referrals.
• A generalist is able to assess a wide range of symptoms, diagnoses, and conditions and build a treatment plan.
• Generalists include general practitioners, family practitioners, and internists.
• General practitioners treat acute and chronic illnesses and provide preventative care using a holistic approach.
• Internists provide comprehensive care of adults.
• They diagnose and treat chronic long-term conditions and must have a broad understanding of the body and its ailments.
• A deductible is a specific amount of money patients must pay out of pocket before the insurance carrier begins paying.
• An explanation of benefits is a statement from the insurance carrier detailing what was paid, denied, or reduced in payment.
• It contains information regarding amounts applied to the deductible, coinsurance, and allowed amounts.
• Remittance advice is an explanation of benefits sent to the provider from the insurance carrier.
• It is similar to an explanation of benefits, as it contains multiple patients and providers and includes electronic fund transfer information or a check for payment.
• A participating provider is providers who agree to write off the difference between the amount charged by the provider and the approved fee established by the insurer.
• Medicare covers patients age 65 and older by Part A hospitalization and Part B routine medical office visits.
• Tricare authorizes dependents of military personnel to receive treatment from civilian providers at the expense of the federal government.
• CHAMPVA covers surviving spouses and dependent children of veterans who died as a result of service-related disabilities.
• Medicaid provides health insurance to the medically indigent population through a cost-sharing program between the federal and state governments.
• Managed care plans provide health care in return for preset scheduled payments and coordinated care through providers and hospitals.
• Workers’ compensation protects wage earners against the loss of wages and the cost of medical care resulting from an accident or disease as long as the employee is not proven negligent.
• Private insurance plans include Blue Cross Blue Shield, which is the oldest and largest, Aetna, and United Healthcare, which offers two types of managed care models: PPO and HMO.
• The CMS-1500 form is a health insurance claim form for claims submitted by a provider or supplier.
• The medical assistant must have all the information completed, including patient and guarantor demographics and insurance information, diagnostic test, treatment, procedure information, and billing information.
• The form has 33 blocks or items divided into three sections.
• Section 1: Carrier Block contains the address of the insurance carrier and is located at the top of the form.
• Section 2: Patient/Insured Section contains information about the patient or insured and is box 1-13.
• Section 3: Physician/Supplier section contains information about the physician or supplier and is box 14-33.
• The Administrative Simplification Compliance Act requires claims to Medicare to be transmitted electronically.
• If claims are sent to a clearinghouse, then paper claims can be sent.
• Electronic claims are submitted through direct billing or to a claims clearinghouse.
• Direct billing allows an insurance carrier to allow a provider to submit insurance claims directly to the carrier electronically.
• Clearinghouse submissions allow providers to submit all insurance claims using distinctive software.
• A clearinghouse audits and sorts the claims and sends them electronically to each insurance company.
• Once services are rendered, the provider must submit the claims within a certain time.
• Medicare and Medicaid claims cannot be filed to the carrier any later than 12 months after the date of service.
• The five rights are the right patient, medication, dose, time, and route.
• Now, the original five rights, plus the right technique and the right documentation are essential when administering medication:
• Primary care clinics and specialty care clinics are outpatient care settings.
• Primary care clinics are outpatient care settings where patients are seen for routine type visits, including wellness checks and minor acute needs.
• Specialty care clinics are outpatient facilities where patients who have complex or severe diseases and conditions visit doctors who specialize in a specific disease or condition.
• Home health refers to specific types of care provided to those who cannot leave their home easily.
• It is ordered for a set period, which is often based on an acute event, usually hospitalization, and is not used on an ongoing basis for a patient.
• Mobile health units bring health care to the communities that most need it and may otherwise lack access to the services provided.
• Hospice care is end-of-life care focused on comfort rather than curative efforts.
• Patients can qualify for hospice care if they have a terminal illness at the end stage.
• Patients will begin in hospice outpatient but can transition to inpatient care as they need a higher level of care near the end of life.
• Urgent care provides an alternative to the emergency room.
• It has a shorter wait time, is often conveniently located, offers walk-in appointments, has flexible hours, and costs less.
• It is appropriate to use for non-life-threatening acute injuries and illnesses.
• Laboratory services perform diagnostic testing on blood, body fluids, and other specimens to conclude a diagnosis for the provider.
• Diagnostic imaging machines such as x-ray equipment, ultrasound machines, magnetic resonance imaging (MRI), and computerized tomography (CT) take images of body parts to further diagnose a condition.
• Occupational therapy assists patients who have conditions that disable them developmentally, emotionally, mentally, or physically.
• It helps the patient compensate for the loss of functions and rebuild to a functional level.
• Physical therapy assists patients in regaining mobility and improving strength and range.
• The impairment is often caused by an accident, injury, or disease.
• Acupuncture involves pricking the skin or tissues with needles to relieve pain and treat various physical, mental, and emotional conditions.
• Chiropractic medicine diagnoses and treats pain and overall body function through spinal manipulation and alignment.
• Energy therapy clears cellular memory through the human energy field to promote health, balance, and relaxation.
• Energy Therapy centers on the connection between life's physical, emotional, and mental states that are found in various holistic healing techniques.
• Dietary supplements contain one or more dietary ingredients, including vitamins, minerals, herbs, or other botanicals.
• A plant or part of a plant such as flowers, leaves, bark, fruit, seeds, stems, roots, or amino acids is used for its flavor, scent, or potential therapeutic properties.
• Vitamin A promotes night vision, cell growth, maintenance, and the health of the skin.
• Vitamin D aids calcium absorption, bone and tooth health, and heart and nerve function.
• Vitamin E protects cells and aids the formation of blood cells
• Vitamin K is responsible for blood clotting and bone growth.
• Vitamin B1 helps with carbohydrate metabolism, heart, nerve, and muscle function.
• Vitamin B2 helps with fat and protein metabolism.
• Vitamin B3 helps with carbohydrate and fat metabolism.
• Vitamin B6 provides enzyme assistance in amino acid synthesis.
• Vitamin B12 promotes protein and fat metabolism, nerve-cell maintenance, and cell development.
• Vitamin C aids in immunity, iron absorption, and the structure of bones, muscle, and blood vessels.
• St. John's wort treats depression, anxiety, and sleep disorders.
• Black cohosh relieves menopause symptoms, including hot flashes, night sweats, headaches, heart palpitations, and mood changes.
• Melatonin is a supplement to potentially help with sleep regulation and combat aging; studies validate sleep regulation support, but do not support the anti-aging benefits.
• Willow bark provides pain relief.
• Glucosamine sulfate promotes healthy cartilage formation to maintain or replace wear and tear on joints.
• Ginkgo biloba improves memory and mental function by increasing blood flow to the brain.

Module 2: Anatomy & Physiology

• Cells are the building blocks of life.
• Every living thing starts as a single cell, which duplicates exponentially over time.
• Cells all have the same foundational components.
• The nucleus contains genetic material for the cell.
• Ribosomes are small complex proteins that assemble proteins from messenger RNA (mRNA).
• The Golgi apparatus packages proteins into membrane-bound vesicles for excretion from the cell.
• The endoplasmic reticulum synthesizes cellular materials and is subdivided into smooth endoplasmic reticulum and rough endoplasmic reticulum.
• The nucleolus is a substructure of the nucleus that synthesizes ribosomal RNA.
• Mitochondria are the powerhouse of the cell, performing cellular respiration.
• Vacuoles are empty "bags" within the cell.
• Vesicles are packages of cell membrane that contain materials for transport into or out of the cell.
• The cytoskeleton is a scaffolding of tubes providing internal support for the cell.
• Flagella, cilia, and pili are protein filaments that allow cells to move.
• The cell wall is a cellulose structure supporting the cell and is only present in plant cells.
• Chloroplasts are photosynthesizing organelles and are only present in plant cells.
• The central vacuole is a large water-filled sac in the middle of plant cells and are only present in plant cells.
• Lysosomes are structures containing enzymes that break down unwanted materials and are only present in animal cells.
• Centrosomes are organelles containing centrioles and are only present in animal cells.
• The sagittal plane divides the body into left and right sides.
• Midsagittal refers to an equal division of left and right sides, running along the midline of the body.
• The transverse plane divides the body into upper and lower sections, though not necessarily equally.
• The frontal plane, also called the coronal plane, divides the body into anterior and posterior sections.
• The cranial cavity is within the skull and houses the meninges (brain).
• The spinal cavity travels down the midline of the back and is formed by the vertebrae and contains the spinal cord.
• The thoracic cavity is within the chest and houses the lungs, heart, and major vessels.
• The abdominal cavity is within the abdomen and houses several major organs such as the stomach, liver, gallbladder, and intestines.
• The pelvic cavity is inferior to the abdominal cavity and houses the bladder and reproductive organs.
• When the body systems perform efficiently, the body achieves homeostasis.
• When there is a disruption in the function of a body system, the result can be minor or significant.
• The integumentary system is responsible for protection, temperature regulation, sensation, excretion, and vitamin D production.
• The skin is the largest organ of the body and aids in its functions, such as protection.
• The epidermis is the outermost layer of epithelial tissue and covers the external surface of the body.
• The dermis is a thick layer beneath the epidermis that contains arteries, veins, and nerves.
• The subcutaneous layer is loose connective tissue composed of adipose tissue and lipocytes.
• Hair follicles generate hair.
• Sebaceous glands produce sebum to keep skin and hair soft and prevent bacteria from growing on the skin.
• Fingernails and toenails protect the ends of fingers and toes.
• Sudoriferous glands produce sweat to aid in cooling the body.
• A function of the skin and its accessory organs is protection, temperature regulation, excretion, and Vitamin D production
• The adult axial skeleton has 80 bones, including the skull, vertebrae, and ribs.
• The adult appendicular skeleton has 126 bones, including arms, legs, and the pelvic girdle.
• Ligaments attach bone to bone for joint stability.
• Tendons join muscles to bones which helps in moving extremities.
• Connective tissue or cartilage maintains, protects, and gives form to other tissues and organs.
• It also covers and protects the end of long bones.
• Skeletal muscle, also called voluntary muscle or striated muscle, is responsible for body movement.
• Smooth muscle is found within the walls of hollow organs and blood vessels and in the iris of the eye and is also called involuntary muscle.
• Cardiac muscle is found only in the heart and is cross-fibered to allow the heart to contract from the top and bottom to pump blood.
• The ends of skeletal muscles attach the muscle to a bone with tendons.
• Lymph nodes are small, glandular structures concentrated in the neck, axilla, and groin that produce and store lymphocytes.
• They are home to macrophages that filter lymph.
• An antigen is a foreign substance within the body.
• An antibody is a protein that the body creates in response to specific antigens which are also called immunoglobulins.
• Antibodies B-cells are a type of lymphocyte that can recognize antigens and responds by turning into plasma cells.
• These plasma cells then create antibodies against specific antigens.
• T-cells are a type of lymphocyte that can recognize antigens and attaches to them to attack the invading cells directly.
• Monocytes engulf and destroy pathogens that have been coagulated with antibodies.
• Naturally acquired active immunity occurs when a person has an infectious disease and then develops antibodies against the pathogen that caused the disease.
• The antibodies have a memory that prevents future infections by the same pathogen.
• Artificially acquired active immunity results from administering a vaccination.
• Antibodies are activated by the vaccine and develop memory to recognize the pathogen in the future.
• Naturally acquired passive immunity is short-lasting immunity transferred through the placenta and breast milk.
• Artificially acquired passive immunity is short-lasting immunity created by giving an exposed person antibodies containing blood products, as in an immune globulin.
• The heart functions as a pump to move blood throughout the body.
• Arteries and arterioles are thick-walled vessels that carry blood away from the heart.
• Smaller branches are arterioles.
• Veins and venules are vessels that carry blood toward the heart.
• Smaller branches are venules.
• Capillaries are the smallest blood vessels, which connect arterioles to venules, and aid in the exchange of oxygen and nutrients between blood and body cells.
• The endocardium is the innermost layer of cells that lines the atria, ventricles, and heart valves.
• The myocardium is the muscular layer of the heart.
• The pericardium is the outermost layer of the heart, as it is a membrane that surrounds the heart and secretes pericardial fluid.
• The average adult heart beats 60 to 80 times per minute while at rest.
• MI is the abbreviation for myocardial infarction, the clinical term for a heart attack.
• The heart's atria receive blood (deoxygenated from the body via the vena cavae in the right atrium, and oxygenated from the lungs via the pulmonary veins in the left atrium).
• The ventricles pump blood (the right ventricle sends deoxygenated blood to the lungs via the pulmonary artery, and the left ventricle sends oxygenated blood to the body via the aorta).
• The urinary system: The kidneys are located on either side of the vertebral column at the level of the top lumbar vertebrae.
• The kidneys are responsible for removing waste from the blood and producing urine.
• Ureters are long tubes which are responsible for carrying urine from the kidneys to the urinary bladder.
• The the small muscular sac located in the pelvic cavity (the urinary bladder), stores urine.
• The urethra carries urine from the urinary bladder to the outside of the body, it is longer in males due to pelvic shape and position of the prostate.
• The urinary system's primary responsibility is to filter blood to rid off waste products and urine is stored in the urinary bladder then await elimination.
• The gastrointestinal system: The mouth (oral cavity) initiates digestion, both mechanical (chewing) and chemical (saliva).
• The pharynx is also the throat, with is both a passageway for food between the oral cavity and the esophagus and air.
• The esophagus muscular tube that uses wave-like contractions to propel food into the stomach, called peristalsis.
• The stomach is located below the diaphragm in the left upper quadrant (LUQ), where food receives food from the esophagus and continues breakdown using gastric juices, and propels food to the small intestine.
• The small intestine mostly fills the abdominal cavity and primarily responsible for absorption of nutrients..
• The small intestine divided into the duodenum, jejunum, and ileum.
• The large intestine, also called the colon, mostly completes absorption and forms feces from solid waste products.
• The rectum stores feces until defecation.
• The anus is the end of the rectum, which opens to the outside of the body to allow for elimination of feces.
• The liver is located in the right upper quadrant (RUQ) where it produces bile needed to break down fats.
• The gallbladder, which is inferior to the liver, stores bile and connects to the duodenum.
• The pancreas is posterior to the stomach and connected to the duodenum and produces enzymes that aid with digestion.
• The respiratory system: The nose is made of bones, cartilage, and skin, consisting of small hairs called cilia to prevent large particles from entering.
• The pharynx directs air through the nose and mouth during respiration into the pharynx and is also part of the digestive system.
• The larynx is superior to the trachea and produces a person's voice.
• The trachea, also called the windpipe, extends from the larynx and branches into bronchi and is lined with cilia.
• The lungs are two cone-shaped organs located in the chest with bronchi, alveoli, and many blood vessels.
• The right lung is larger than the left lung and is divided into three lobes, whereas the left lung has two lobes.
• The lungs are surrounded by a membrane called pleura.
• The function of respiratory system is to move air into and out of the lungs (respiration or breathing), the respiratory and cardiovascular systems work together to help deliver oxygen to the body via the blood and eliminate carbon dioxide.
• The nervous system controls all other body systems and is divided into two main sections, the central nervous system (CNS) and peripheral nervous system (PNS).
• The CNS includes the brain and spinal cord.
• The PNS is made of peripheral nerves found throughout the body.
• The somatic nervous system controls the body's voluntary (skeletal) muscles.
• Afferent nerve cells, called neurons, carry information about the body's environment to the CNS.
• Efferent neurons carry responses from the CNS to the body to initiate action.
• The brain coordinates most body activities and is the control center for the body, as well as thought, emotion, and judgment and is divided into four lobes (frontal, parietal, occipital, and temporal).
• The spinal cord provides a pathway for nerve impulses travelling to and from the brain and extends from the base of the brain to the lumbar vertebrae through the vertebral column.
• The peripheral nerves include 12 pairs of cranial nerves and 31 pairs of spinal nerves branching off from the spinal cord, and they carry nerve signals between the body and the brain.
• A neuron is the structural and functional unit of the nervous system.
• Dendrites have multiple branching structures.
• The nucleus directs cellular activities.
• The cytoplasm produces neurotransmitters and energy for the neuron.
• The axon stores neurotransmitters.
• The endocrine system is made of organs and glands that produce,store and release hormones.
• Hormones are chemicals used by the blood to increase or decrease activity of the hormone's specific target cells, this also aids the body in maintaining homeostasis.
• There are two types of glands within the system, exocrine and endocrine.
• The exocrine glands release hormones into a duct for delivery to the target cells.
• The endocrine glands release hormones directly into the bloodstream.
• There are many different organs that make up the endocrine system throughout the body.
• The male and female reproductive systems work together to achieve fertilization and produce offspring.
• Type 1 is a disorder in which the body lacks the ability to make insulin, whereas type 2 is a disorder in which the body is resistant to insulin. Symptoms associated with Type 1 diabetes typically presents starting in childhood, whereas type 2 is not typically expressed until adulthood.
• All three forms of technology: X-rays, CT scans, and nuclear medicine testing all use radiation, whereas MRI uses magnetic waves, and ultrasound uses sound waves.
• The prefix presby- refers to older age.
• Trust vs. Mistrust takes place during infancy when infants develop trust by forming secure bonds with caregivers, otherwise, failure results in mistrust and difficulty in relationships.
• Autonomy vs. Shame and Doubt takes place during the toddler years, these individuals in this stage develop independence and self-control; failure leads to shame, doubt, and lack of confidence.
• Initiative vs. Guilt takes place during the school-age Preschooler, who explore and take initiative; failure results in guilt, inadequacy, and hesitation to try new things.
• Industry vs. Inferiority takes place during the school-age years, who build competence through accomplishments otherwise, failure leads to feelings of inferiority and lack of cooperation.
• Identity vs. Role Confusion takes place during the Adolescent years when teenagers form a personal identity and direction in life; failure leads to confusion, poor decisions, and lack of confidence.
• Intimacy vs. Isolation takes place in young adults, as young adults form meaningful relationships and commitments, but failure results in loneliness and social withdrawal.
• Generativity vs. Stagnation takes place in Middle adults, as the adults contribute to future generations otherwise, failure leads to self-centeredness and lack of productivity.
• Ego Integrity vs. Despair takes place in older adults, as older adults find peace and self-worth in life's achievements ; failure leads to regret, depression, and fear of death.

Stressors:

• There are over 300 recognized mental illnesses.
• Environmental stressors, aka physical stressors, include situations that cause enough stress to become obstacles to achieving goals or having positive experiences.
• These physical stressors can be in the environment (air pollution, ultraviolet rays from excessive sun exposure, overcrowding, language and cultural barriers, and discrimination.) that cause the body physical stress.
• Many people undergo a great deal of stress over financial situations.
• Medical offices and facilities are legally required, according to the Americans with Disabilities Act to have appropriate access for patients who use wheelchairs or other assistive devices.

Defense Mechanisms:

• Apathy: is the indifference; and lack of interest, feeling, concern, or emotion in someone's well being.
• Compensation: is the act of Balancing a failure or inadequacy with an accomplishment.
• Conversion: Transformation of an anxiety into a physical symptom that has no cause.
• Denial: is the act of avoiding unpleasant or anxiety-provoking situations or ideas by rejecting them or ignoring their existence.
• Displacement: a redirection of emotions away from the original subject or object onto another, less-threatening subject or object.
• Dissociation: disconnection of emotional importance from ideas or events and compartmentalizing those emotions in different parts of awareness of a situation.
• Identification: attribution of characteristics of someone else to oneself or the imitation of another.
• Intellectualization: analysis of a situation with facts and not emotions.
• Introjection: adoption of the thoughts or feelings of others .
• Physical avoidance: is keeping away from any person, place, or object that evokes memories of something unpleasant.
• Projection: is the transference of a person's unpleasant ideas and emotions onto someone or something else.
• Rationalization: explanation that makes something negative or unacceptable seem justifiable or acceptable.
• Reaction formation: belief in and expression of the opposite of something's true feelings .
• Regression: reversion to an earlier, more childlike, developmental behavior.
• Repression: elimination of unpleasant emotions, desires, or problems from the conscious mind.

Module 3: Patient Intake and Vitals

• Patient Identification & Demographic Verification: Demographics are to be Verified at. Each Visit includes name, address, phone number, insurance details, and emergency contact.
• Each Patient Has a Unique Medical Record: Some systems use a medical record number for identification.
• Two Identifiers should be used for proper Patient Identification for Safety; Most commonly, use their full name and date of birth (DOB).
• Avoid Leading Questions by not stating the patient's name and ask for confirmation, as patients may respond incorrectly, especially in stressful situations.
• Financial Verification: Common Identifiers for Billing include the full name and the last four digits of Social Security number (SSN).
• When being mindful of Confidentiality Considerations, Full SSN is rarely requested so, in the Face-to-Face Care Identification, Name and DOB are the most used identifiers.
• Patient Screening & Medical History: the Screening Process (Rooming Patients) Collects initial information before seeing the provider.
• It Always includes chief complaint and medication review.
• Chief Complaint (CC): is the main reason for the visit, stated in the patient's own words using quotation marks when documenting.

Subjective vs. Objective Information:

• Subjective: is the Patient's description (e.g., “My stomach hurts” – not measurable as it cannot be.
• Objective: Measurable or observed information (e.g., past diagnoses, lab results).
• Medication & Allergy Review: Medication Reconciliation ensures that: ○ The patient's current medications are compared with the medical record at every visit. ○ to prevent drug interactions and prescription errors. Allergy Documentation: to ask about the type of allergy and the reaction (e.g., rash, anaphylaxis). Electronic records provide alerts, whereas paper charts use red ink or stickers for documenting

Personal, Family & Social History:

• It's collected at the first visit and updated regularly, and helps identify disease risks.
• Includes: Medical History of past illnesses, and surgeries.
• Family History that includes diseases in the immediate family.
• And the Social & Occupational History consisting of lifestyle habits (diet, smoking, alcohol, drug use), and job hazards.
• Health Record Components: include Administrative: Patient demographics, insurance, and financial info.
• Clinical: Medical history, medication list, allergies, referrals, and diagnostic tests.

Lifestyle & Wellness Screening: Its Purpose is to identifies health risks and determines the need for further assessments. Topics Covered:

• Substance Use consisting of alcohol, tobacco, caffeine, and recreational drugs.
• Sexual Practices can indicate the need for HIV screening or other health concerns.
• Occupational Hazards consists of Exposure to asbestos, machinery risks, or other workplace dangers.
• Diet & Exercise helps assess overall health and risk factors.
• Patient Comfort should be considered as Some may feel uncomfortable or refuse to answer.
• It they decline, document “patient declined to answer” in their medical record.
• Mental Health Screening: its Purpose is assess patient safety, mood, and mental status.
• Use Depression Screening Tools: Use the PHQ-2 to Screens for depressed mood over the past two weeks or, use the: PHQ-9: If the PHQ-2 suggests possible depression, then assesses for a depressive disorder.
• Mini-Mental State Exam (MMSE): Used for older adults to screen for dementia or cognitive decline.

Common Depression Symptoms:

• Difficulty sleeping or waking up as well as profound sadness and fatigue.
• Also, pay attention to appetite changes and loss of energy.
• Anxiety Screening & Symptoms: Use the GAD-7 Questionnaire: This screens for generalized anxiety disorder.
• Commen Anxiety Symptoms: Panic, irritability, difficulty focusing, sweating, cold feeling, heart palpitations, shortness of breath, and a "White coat syndrome" (anxiety during medical visits)

Blood Pressure & Measurement Techniques:

• Blood Pressure Definition: Measures the force of blood circulating through the arteries measuring in mm Hg (millimeters of mercury). Systolic Pressure: is the first sharp tapping sound also known as Phase I of Korotkoff sounds. Diastolic Pressure: Last sound heard before blood flows freely also, Phase V. Measurement Methods:
• Manual: Uses sphygmomanometer (BP cuff) and stethoscope.
• Electric: Can measure BP without auscultation.
• Palpatory Method: Used in emergency situations to determine systolic BP by feeling the radial pulse.
• Factors Affecting Blood Pressure Readings: can range from cuff issues (wrong size, incorrect placement, or improper inflation/deflation) to the the patient positioning.

Different Factors affecting Blood Pressure.

• The arm should not be supported , as this will cause a false High reading due to muscle tension.
• Do not cross legs --> because legs crossed can raise systolic BP by 2-8 mm Hg.
• Different External Factors: Anxiety, smoking, caffeine, rapid cuff deflation, incorrect timing between readings.
• Orthostatic Hypotension: is defined as A drop in BP when a person move from lying to sitting or standing and is often associated with:
• Symptoms like Dizziness, fainting, and a rapid pulse. It's Caused By causes: Dehydration, heart disease, diabetes, medications which is tested using the Testing Protocol (CDC Guidelines):

1. Lie down for 5 minutes, and measure the BP & pulse.
2. Stand, and measure the BP & pulse at 1 min & 3 min.
3. Check. A 20+ mm Hg drop in systolic BP or 10+ bpm rise in pulse which indicates orthostatic hypotension.
4. Ensure patient safety—assist if dizziness occurs.

• Pulse (Heart Rate) Measurement its function is to show the number of heartbeats per minute, and should be performed using the technique: ○ Use the second and third fingers to palpate the pulse and count beats for one full minute. Pulses on the wrist, thumb side (Radial) is the most common location to gather results on adutls. Use the Brachial on the inner upper arm, most common used for children & blood pressure measurement, whereas, the carotid artery in the neck, below the jawbone is used in emergency. The Apical Pulse (Auscultation Method): Measured with a stethoscope that must listen to the heart at its apex for it to be effective and commonly used for infants, children, and irregular heartbeats. Important Pulse Characteristics to know consist of:
• Rate: Beats per minute (e.g., 70/min).
• Rhythm: Is to check their Regularity: Regular or irregular.
• Strength which is a Threadiness: Weak, hard to detect rather then a Bounding: Strong, forceful result.
• Common Pulse Points
• Various Factors Affecting Pulse Rate consist of : the patient's age, Acivity, their Medications, or the Time of Day.
• Adolescent and older should be 60 to 100 whereas, school aged children should be around 75- 118 BPM.

Different Breathing Patterns & Rate by Age:

• Respiratory Rate Assessment: Measured by the amount of breaths is person takes per minute being that one inhalation plus one exhalation equals one breach.
• Key factors are to maintain it's normal Rate compared to when it's abnormal due to having Tachypnea which equals to fast breaths, whereas, bradypnea = slow breaths.
• Rhythm: Is to check the regularity of breaths or if it needs to be followed up on as irrugular breathing.
• Important depths to take into considerations that should show a Shallow, normal, or deep breaths.
• The best practices to know for an Accurate Measurement comes from that:
• Patients may control breathing if they know what is being counted, so observe Discreetly and be commonly measured right after the pulse to avoid patient awareness.
• Remember to count for 30 seconds and multiply by two or, in fact, a full minute for accuracy.
• Be sure to listen for sounds such as: Wheezing (whistling), rales (crackling), and rhonchi (rattling/snoring) sounds.

Pulse Oximetry test:

• It's indicated that Nail polish and artificial nails block the infrared light of the oximeter and interfere with the results so, they should be removed prior to the test, or an alternate site should be used to obtain a reading. Measures: Oxygen saturation (SpO2) in the blood using infrared light.
• Common sites consist of The Finger the most common and the Earlobe