Essentials of Human Diseases and Conditions (Sixth Edition) PDF

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Go to evolve.elsevier.com/html/shop-promo.html to search and browse for products. Essentials of Human Diseases and Conditions Sixth Edition This page intentionally left blank Essentials of Human Diseases and Conditions Sixth Edition Margaret Schell Frazier, RN, CMA (AAMA), BS Retired Former Chair, Health and Human Services Division Program Chair, Medical Assisting Program Ivy Tech State College, Northeast Fort Wayne, Indiana Clinical Director Faith Community Health Clinic Angola, Indiana Presently President/Consultant/Author, M & M Consulting Hudson, Indiana Jeanette Wist Drzymkowski, RN, BS Formerly Associate Faculty Ivy Tech State College, Northeast Fort Wayne, Indiana Presently Author Laguna Niguel, California 3251 Riverport Lane St. Louis, Missouri 63043 ESSENTIALS OF HUMAN DISEASES AND CONDITIONS, SIXTH EDITION ISBN: 978-0-323-22836-7 Copyright © 2016 by Elsevier, Inc. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher. Details on how to seek permission, further information about the Publisher’s permissions policies and our arrangements with organizations such as the Copyright Clearance Center and the Copyright Licensing Agency, can be found at our website: www.elsevier.com/permissions. This book and the individual contributions contained in it are protected under copyright by the Publisher (other than as may be noted herein). Notices Knowledge and best practice in this field are constantly changing. As new research and experience broaden our understanding, changes in research methods, professional practices, or medical treatment may become necessary. Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information, methods, compounds, or experiments described herein. In using such information or methods they should be mindful of their own safety and the safety of others, including parties for whom they have a professional responsibility. With respect to any drug or pharmaceutical products identified, readers are advised to check the most current information provided (i) on procedures featured or (ii) by the manufacturer of each product to be administered, to verify the recommended dose or formula, the method and duration of administration, and contraindications. It is the responsibility of practitioners, relying on their own experience and knowledge of their patients, to make diagnoses, to determine dosages and the best treatment for each individual patient, and to take all appropriate safety precautions. To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors, assume any liability for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the material herein. Previous editions copyrighted 2013, 2009, 2004, 2000, and 1996. Executive Content Strategist: Jennifer Janson Content Development Manager: Ellen Wurm-Cutter Content Development Specialist: Kristen Mandava Publishing Services Manager: Julie Eddy Senior Project Manager: Marquita Parker Designer: Margaret Reid Printed in Canada Last digit is the print number: 9 8 7 6 5 4 3 2 1 Sixth Edition Editorial Review Board Professional Reviewers Julie C. Risley, MS, PA-C Physician Assistant Leon J. Baginski, MD, FACOG Fort Wayne Physical Medicine San Clemente, California Fort Wayne, Indiana William W. Chang, D.O. Elaine M. Rutkowski, PhD, RN Diplomat, American Board of Internal Medicine, Associate Professor Pulmonary Diseases, and Critical Care California State University, Fullerton Medicine Fullerton, California Attending Physician, Paloma Medical Group Cofounder/Executive Vice President, Pacific Rick J. Storie, MPAS Private Practice Network Physician Assistant San Juan Capistrano, California Fort Wayne, Indiana Assistant Clinical Professor, Loma Linda University Medical Center Michael P.M. Troung, MD Loma Linda, California Physician Staff Physician, Mission Hospital Mission Internal Medical Group Mission Viejo, California Mission Viejo, California Carolyn Y. Davis, PhD, RN, CPNP Susan Elizabeth Zimmer, BSN Pediatric Nurse Practitioner Staff Emergency Room Nurse Associate Professor of Nursing Cameron Hospital Goshen College Angola, Indiana Goshen, Indiana Academic Reviewers Alicia A. Elliott. PMHCNS Parkview Behavioral Health Stephanie Clack, CHIM Fort Wayne, Indiana Instructor, Health Information Management SAIT Polytechnic Kendra G. Hansen, DNP, ANP-BC Calgary, Alberta University of St. Francis Joliet, Illinois Teresa Cowan, MS Department Chair of Health Sciences Sean Indra, MD Baker College of Auburn Hills Children’s Hospital of Michigan Auburn Hills, Michigan Detroit Medical Center Detroit, MI v vi Sixth Edition Editorial Review Board Dr. Kimberly Head Julie A. Shellenbarger, MBA, RHIA Collin College Assistant Professor Plano, Texas Health Information Technology University of Northwestern Ohio Dolly R. Horton, CMA(AAMA), M.Ed. Lima, Ohio Dean, Allied Health and Public Service Asheville Buncombe Technical Community Lisa A. Smithart, BS, RMA, NRCPT, CHW College Medical Programs Administrator and Faculty Asheville, North Carolina Dallas County Community College District Richland College Deborah L. Mahoney, RN, MSN, CCM Dallas, Texas Adjunct Faculty Union County College Cathy D. Soto, PhD, MBA, CMA(AAMA) Cranford, New Jersey CEO, Global Education Co. College of St. Elizabeth El Paso, Texas Morristown, New Jersey Brian Spence, BSRS, RT(R) Debra J. Paul, BA, CMA-AAMA Assistant Professor of Radiologic Technology Ivy Tech Community College Tarrant County College South Bend, Indiana Fort Worth, Texas Cindy Pavel, MPA, BA, BS, LMT, Pam Ventgen, CMA(AAMA), CPC, CPC-I, CMA(AAMA) CCS-P Medial Assistant Program Director Professor North Idaho College University of Alaska Anchorage Coeur d’Alene, Idaho Anchorage, Alaska Contributing Authors Pegi Boswell, MS, LMFT Carol O’Hear, MD, PhD Owner/Therapist Assistant Medical Director The Santé Group, Inc. Cancer Immunotherapy Angola, Indiana Genentech South San Francisco, California Gregory Folck, RPh Registered Pharmacist William Shiel, Jr., MD, FACP, FACR Fremont, Indiana Chief Editor, MedicineNet.com Clinical Rheumatologist Jennifer Gerig, RN Mission Heritage Medical Group Adams Memorial Hospital Mission Viejo, California Decatur, Indiana vii Acknowledgments Special thanks go to the Elsevier experts involved in the Parker, Senior Project Manager, thank you for your publication of this text. Thank you Andrew Allen, expert diligence as you prepared our words and illus- former Vice President and Publisher of Health Profes- trations as final pages for print. Anne Simon, Content sions, for your positive vision and continued support Marketing Manager, whose team will be presenting the of this book. We gratefully acknowledge Jennifer book to prospective educational partners, a big thank Janson, Executive Content Strategist, for her guidance you for understanding the goal of the authors as they and suggestions during the rewrite of this book. Kristen designed the manner in which material would be pre- Mandava, Content Development Specialist, thank you sented. Thanks go to our contributing authors and for your patience with us as you interpreted our files many professional reviewers. To our families who have and arranged it all in an acceptable form. It has been a been patient with and understanding of us through the pleasure working with you. Rachel Allen, Content 20 plus years we have been working on these books, a Coordinator, thank you for handling our problems huge thank you is expressed. Finally, to each other, it and making sure all our contributors and reviewers has been a long journey and one that has endured were compensated for their contributions. Marquita lengthy distances and strengthened our friendship. viii  To Dave, my soul-mate, my best friend, my advisor my strength, and the love of my life. Your love will always sustain me. Thank you for respecting our promise to forever love, honor, and cherish and to allow each of us to grow in our own way as stated best by Gilbran in The Prophet: “Give your hearts, but not into each other’s keeping. For only the hand of Life can contain your hearts. And stand together yet not too near together: For the pillars of the temple stand apart, And the oak tree and the cypress grow not in each other’s shadow.” The Prophet by Kahlil Gibran As you travel down your path into the sunset, my love will always be with you. To our beloved grandchildren, you are my helpers and our hope for the future. Blessings and love, Margie and Grandma To my daughter and three sons, who still think I can do anything! To my husband who is always there to see that I can do anything! Jeanette This page intentionally left blank Preface Essentials of Human Diseases and Conditions, Sixth Chapter 4 has further explanation of the medical Edition, is a user-friendly reference intended to serve emergencies associated with endocrine dis- as a stimulating and practical textbook for students eases such as hypothyroidism, and the latest on and an invaluable tool as a handbook for health-care insulin replacement and oral drug therapy for providers in any type of health-care setting. Instruc- diabetics. tors of such classes as anatomy and physiology, disease Chapter 5 has new illustrations of otosclerosis and conditions, medical insurance coding, pharmacology, cholesteatoma. massage therapy, and medical transcription will likely Chapter 6 includes a new illustration of shin- appreciate the value of this edition as a required text. gles and a photo of an individual with ocular This encyclopedic but simplified handbook includes rosacea. comprehensive information about hundreds of dis- The many cancers that can inflict the digestive eases and conditions. Students in the field of medical system from the mouth to the anal canal are metic- assisting, medical transcription, medical insurance ulously updated and discussed in Chapter 8. coding, pharmacy technology, massage therapy, or In Chapter 9, new radiograph illustrations have other allied health programs that have had a prior been added demonstrating health and disease of introduction to basic anatomy and physiology the respiratory system. Newer diagnostic approaches of the human body and medical terminology will and treatments of respiratory diseases are discussed. find the text format orderly, concise, and easy to Lung cancer, the leading cause of male & female comprehend. death from cancer in 2014, is discussed with the latest medical facts in practice. Distinctive Features of Our Approach Chapter 10 includes an illustration showing agglu- tination of red blood cells during blood transfusion Content and topics new to this edition include: incompatibility reaction and an illustration of clot- In Chapter 2, new illustrations have been added of ting cascade where Factor VIII is inactive. conjoined twins after birth, a heart with cardiomy- In Chapter 11, information on bladder cancer has opathy, phimosis, raccoon eyes, radiographs of a been updated. myelomeningocele and of the lungs of a child with In Chapter 12, discussion of the male reproductive asthma, and charts comparing cyanotic and cya- diseases has been broadened. Additionally, a thor- notic heart defects in newborns and comparing oughly updated presentation of sexually transmit- features of individuals with Klinefelter’s and ted diseases, many of which are considered to be Turner’s Syndromes. epidemic, is found. Chapter 3 includes new findings relevant to the The Glasgow Coma Scale, table of Major Compo- treatment and prevention of AIDS. nents of Cranial Nerves, Illustration of the xi xii Preface autonomic nervous system and a discussion of the musculoskeletal system. Chapter 8 addresses the traumatic brain injuries (TBI) have been added to body’s nourishment system: the gastrointestinal system Chapter 13. and its accessory organs. Chapter 9 presents material Change from DSM-IV to DSM-V is discussed in for the oxygen and carbon dioxide exchange, the respi- Chapter 14, and information regarding neuroleptic ratory system. The cardiovascular system (the heart, syndrome has been added. the blood, and the vessels) are the topic of Chapter 10. In Chapter 15, discussions about recommenda- Chapter 11 follows with a discussion of the urinary tions for patients who experience metal fragments system, the system that maintains homeostasis and in their eyes are as are discussions about mock is a major factor in excretion of urinary waste prod- disaster drills. Various forms required for emer- ucts. Chapter 12 discusses both male and reproductive gency department reporting are listed. Change to productive systems, pregnancy, and disorders of the prophylaxis with tetanus, diphtheria and pertussis breasts. Chapter 13 covers the neurological systems’ injection (Tdap) is included. diseases and conditions. Chapter 14 is a discussion of A logical and orderly approach to exploring patho- mental disorders, including phobias, grief response, physiological conditions flows from the information posttraumatic stress disorders, alcohol abuse, sleep of diseases as their progression from general concepts disorders, and other conditions covered by DSM-V. to the beginning of life and diseases and conditions of This chapter also includes a comprehensive chart on childhood. General concepts in disease are presented drugs of abuse, their street names, and their effects in Chapter 1 as a basis for discussion of conditions. on the abuser. Chapter 15 includes information that Chapter 1 introduces the reader to general principles aids health care providers with practical knowledge of pathophysiology. In conjunction with a breakdown when faced with a variety of traumatic injuries. This of the mechanisms of disease, the subject matter flows material includes lightning injuries; insect, animal, through integrant aspects important for the student to and snake bites; child abuse; psychological abuse; consider in the study of human diseases, such as genet- elder abuse; sexual abuse; intimate partner abuse; ics, immune disorders, preventive health care, nontra- and rape. ditional medicine and patient teaching. Additionally, cancer is introduced in Chapter 1 with foundational Organization of Material information about the pathology, pathogenesis, and prognostic indicators of the disease (staging and Each chapter is introduced with a brief review of grading of malignant tumors). Specific sites and types the normal function of the specific body system dis- of cancers are then comprehensively addressed in sub- cussed in the chapter, and this review is reinforced sequent chapters. This is followed by a discussion of with clear illustrations. Important pathologic mecha- pediatric situations in Chapter 2. After these general nisms are explained and illustrated as well. A disease discussions, the text progresses through body systems entity is presented with a description and discussion from Chapters 3 to 12. Chapter 3 introduces the of the symptoms experienced by the patient and signs student to the immune system, including immuno- detected by the physician. The chapters continue with deficiency disorders autoimmune disorders. This is sections devoted to etiologic factors, diagnosis, treat- followed by Chapter 4, the endocrine system, its dis- ment options, prognosis, prevention, and patient orders resulting from both deficiency and over activity teaching related to the disease entity. A diagnostic of the endocrine system. This is followed by the special code is assigned to each disease entity. (See important senses of sight and hearing in Chapter 5. Chapter 6 notes at the end of the preface.) ICD-9-CM and progresses to the largest sensory organ, the skin, or ICD-10-CM codes are included to aid in locat- integumentary system and its disorders. Chapter 7 ing appropriate insurance codes. This format also provides the manner that maintains the upright struc- follows the inherent progression of a patient’s experi- ture of the individual and its manner of movement ence: (1) the individual reports symptoms to a health- and disorders that disrupt the normal functioning of care provider, usually in a clinical setting; (2) abnormal  Preface xiii signs of a clinical disorder may be elicited during the In this regard, we also would like to add a list of physical examination and/or subsequent diagnostic serious and life-threatening conditions that require testing; (3) an appropriate treatment option is ini- immediate assessment and intervention. These include tiated and monitored for results; (4) the patient is but are not limited to: given appropriate teaching to encourage compliance Sudden onset of unexplained shortness of breath to ensure an optimal outcome. The usual prognosis Crushing pain across the center of the chest for the condition and possible preventive measures are Difficult breathing occurring suddenly and discussed. rapidly worsening, often in the middle of the Italicized words found in the chapters are defined night in the Glossary for purposes of review or clarification Vomiting of blood that is bright red or with a very of meaning. The advantages to the student and health- dark “coffee grounds” appearance care worker in better understanding clinical terminol- Sudden onset of weakness and unsteadiness or ogy include (1) great professional gain when one severe dizziness comprehends the effects that a disease has on a person, Sudden loss of consciousness or paralysis (2) increased communication skills with the entire Flashes of light in field of vision health-care team, and (3) personal education that has Sudden and progressively worsening abdominal, many practical applications. flank, or pelvic pain The authors believe it is important to define the role Sudden onset of blurred vision accompanied by of patient screening in each discussion. Therefore the severe throbbing in the eye discussion of each particular disease entity begins with A report of any of these symptoms must be imme- a feature called Patient Screening; the remarks therein diately relayed to the physician. The physician will usually are tailored to the disease entity being dis- then offer additional instructions to give to the indi- cussed. Because the vast majority of patients first seek vidual calling for help. access to health-care services by telephone, many The appendices offer valuable information about health-care facilities have a written, standardized diagnostic testing, pharmacology, and resource agen- protocol for medical personnel who take incoming cies. The Common Laboratory and Diagnostic Tests calls. The comments offered in the Patient Screening appendix discusses tests often ordered by the physi- feature of this text are not intended to diagnose cian. Reference values are listed for laboratory tests, the caller’s medical condition or give curative advice. followed by possible causes of each variation above The feature typically offers general clues to recognizing normal or below normal. Reference values or expected the urgency for an appointment, identifying emergen- normal results are discussed for imaging and other cies, and discerning the kind of calls that require studies. Again, causes of variations from normal are referral to the physician for response. This feature is provided. It is imperative that the reader using this not to be confused with the skill of medical triage, information recognize that reference values may vary which state practice acts generally reserve for certain according to the laboratory in which the test is per- licensed professionals. Careful listening to the patient formed and reported. Another appendix contains who is calling often identifies information that helps pharmacology information. Representative drugs are the telephone screener select the appropriate action listed by group and include name of drug, usual required by the caller. Ideally, the outcome of tele- intended therapeutic objective, possible side effects, phone communication between caller and screener and general comments. The presentation of this will benefit the patient and avoid potential medical- appendix follows the chapters in the text. Once again, legal problems. Maintaining sensitivity to human suf- the reader must recognize that drugs and drug sub- fering, keeping strict confidentiality, and upholding stances may be continually changing and that any the priority of meeting the needs of patients cannot be specific material must be confirmed by referencing a overemphasized as skills necessary in a medical tele- current drug reference or pharmacology reference phone screener. source. xiv Preface Chapter Features Key features of each chapter include: 264 CHAPTER 6 Diseases and Conditions of the Integumentary System LEARNING OBJECTIVES After studying Chapter 6, you should be able to: 10. List preventive measures for decubitus ulcers. 1. Explain the functions of the skin. 11. Name the two most common parasitic insects to 2. Recognize common skin lesions. infest man. Describe how infestation can occur. 3. Describe how seborrheic dermatitis affects the 12. Name two common premalignant tumors. skin. 13. Differentiate the three types of skin cancer. 4. Discuss the possible causes of contact dermatitis, 14. Describe the guidelines for avoiding excessive sun exposure. atopic dermatitis, and psoriasis. 5. Describe the treatment of acne vulgaris. 15. List some conditions that are caused by the Each chapter begins with a set of abnormal development or distribution of 6. Explain the pathologic course of herpes zoster. 7. Name the etiology of impetigo. melanocytes. 16. Name some possible causes of alopecia. Learning Objectives that list impor- 8. Explain why the treatment of cellulitis is important. 9. Cite examples of the classifications of fungal 17. State the cause of warts. 18. List some of the likely causes of deformed or tant information the student will be infections of the skin. discolored nails. able to do after reading the chapter KEY TERMS content. bulla (BUL-la) cellulitis (sell-you-LIE-tis) keratolytic (ker-ah-toe-LIT-ik) keratosis (ker-ah-TOE-sis) The Key Terms list provides pro- comedo (KOM-ee-doe) nevus (NEE-vus) dermatome (DER-mah-tome) papule (PAP-youl) nunciations for important words electrodesiccation (ee-leck-tro-des-ih-KAY-shun) plaques (plaks) erythema (eh-rih-THEE-ma) exudate (EKS-you-date) sebaceous (seh-BAY-shus) vesicle (VES-ih-kl) related to chapter content. Bold- exudative (EKS-you-day-tive) fissure (FIS-ur) vesicular (veh-SIK-you-lar) wheal (WHEEL) faced words found in the text are listed in the Key Terms at the begin- ORDERLY FUNCTIONING OF corium (middle layer), is a dense, fibrous layer of con- nective tissue that gives skin its strength and elasticity. ning of each chapter, as well as in the THE INTEGUMENTARY SYSTEM Within the dermis are blood and lymph vessels, nerve fibers, hair follicles, and sweat and sebaceous glands. Glossary unless the term is ade- The system comprising the skin and its accessory organs (hair, nails, and glands) is called the integumen- Third is the subcutaneous layer, a thick, fat-containing section that insulates the body against heat loss. quately defined within the text of the tary system. The skin, one of the largest organs, pro- tects the body from trauma, infections, and toxic Skin diseases frequently are manifested by cutane- ous lesions, or alterations of the skin surface (Table chapter. chemicals. When exposed to sunlight, the skin syn- 6-1). The diagnosis of a cutaneous disease often is thesizes vitamin D. Within the skin are millions of based on the appearance of a specific type of lesion or tiny nerve endings called receptors. These receptors group of lesions (Figure 6-2). sense touch, pressure, pain, and temperature. In addi- Common presenting symptoms that need atten- tion to the skin’s roles in protection, sensation, and tion from health care professionals include: synthesis of vitamin D, it assists in the regulation of Cutaneous lesions or eruptions body temperature and in excretion. Pruritus (itching) The skin has three main structural layers (Figure Pain 6-1). The epidermis (outer layer) is a thin, cellular, Edema (swelling) multilayered membrane that is responsible for the Erythema (redness) production of keratin and melanin. The dermis, or Inflammation 746 CH A P T E R 14 Mental Disorders ENRICHMENT The Child, the Therapist, and Play Therapy Play is a natural means of expression for a child as verbalize, to understand the child’s interactions and well as a way for children to learn and develop a relationships with important people in his or her life, variety of skills. Therapists working with children use and to teach the child appropriate coping play therapy in assessment and treatment mechanisms and adaptive socialization skills. interventions, assisting the child to cope with Children who have been exposed to abuse often emotional stress and trauma. Children often cannot respond to the therapist in the nonthreatening verbalize their thoughts and feelings, and play therapy environment of play therapy. The use of dolls and becomes a nonverbal avenue for them to various toys gives the child a means of acting out Enrichment boxes give the communicate with the therapist. This type of therapy creates a nonthreatening atmosphere for the children. the abuse and offers an avenue for positive interaction. Play therapy may be employed on a one-to-one basis Therapists may use objects and toys during play reader pertinent or relevant informa- or in the group setting. Children are allowed, and occasionally encouraged, to act out or express therapy. All kinds of dolls, a doll house, stuffed animals, puppets, soft balls and foam bats, toy tion that enhances a discussion topic feelings and experiences. During play therapy sessions, the therapist establishes rapport with the vehicles, punching toys, a sand tray, and paper and markers or crayons may be used during play therapy. in the text. child and encourages the child to act out any feelings During these play sessions, family interactions and of anxiety and tension he or she may be experiencing. dynamics may become apparent. Sand therapy may The therapist’s goals are to give the child an include small plastic animals or people and allows the opportunity to reveal feelings that he or she cannot child to act out feelings (Figure 14-3). A B  Preface xv CHAPTER 5 Diseases and Disorders of the Eye and Ear 241 ALERT! Ototoxicity these drugs. Any of the other drugs should not be Ototoxicity occurs when a drug or chemical causes discontinued unless so ordered by the physician. damage to the eighth cranial (acoustic) nerve or to Quinine ototoxicity, like aspirin-induced ototoxicity, the inner ear, resulting in temporary or permanent usually can be reversed when the medication is hearing loss or disturbances in balance. Symptoms and signs of ototoxicity usually have an insidious stopped. Large dosages of antibiotics that may be ototoxic usually are administered in life-threatening Alert boxes provide essential CHAPTER 5 Diseases and Disorders of the Eye and Ear 243 onset and include tinnitus, a feeling of fullness or pressure in the ears, hearing loss, vertigo, and situations. Chemotherapeutic agents are monitored for any warnings (cautions and precautions) ototoxic side effects. In normal dosages, the loop that require discussion or may occasionally nausea. Drugs that can cause ototoxicity include salicylates diuretics usually have veryPrevention few ototoxic side effects; it Diagnosis (aspirin and aspirin-containing products); nonsteroidal is when they are given in massive doses for treatment of acute kidney failure or Preventive measuresthat include keeping the ear clean and An otologic examination and a history of symptoms antiinflammatory drugs (NSAIDs); certain antibiotics (aminoglycosides, erythromycin, and vancomycin); acute hypertension ototoxicity may occur. dry. It is important to also keep earphones, earplugs, require special treatment. confirm the diagnosis. If a bacterial infection is sus- loop diuretics (furosemide [Lasix], bumetanide Environmental chemicals andinclude, hearingbutaidsareclean. not Additionally, the use of anoth- pected, a culture of the material found in the canal [Bumex], and ethacrynic acid [Edecrin]); limited to, butyl nitrite, carbon disulfide, hexane, er’s earphones or earplugs is discouraged. If this is a may be needed to determine how to properly treat the chemotherapeutic agents (cisplatin, vincristine, and styrene, toluene, trichloroethylene, and xylene. usual practice, any shared object placed in the ears infection. vinblastine); quinines (quinidine and quinine); and Once damage has occurred, it cannot be reversed. Hearing loss may should be disinfected be helped somewhatbefore by use. heavy metals, including mercury and lead. hearing aids or cochlear implants. When the patient Treatment The physician should be notified of any of the Patient Teaching aforementioned symptoms when the individual is experiences loss of balance, physical therapy may be It is important for the ear canal to be kept clean taking or going to receive any of the previously needed to help the patient regain the Provide the ability patient to or family with pictures of the and to be dried after swimming. Antibiotic or steroid mentioned medications. balance. anatomy of the ear. Demonstrate how moisture eardrops and systemic antibiotics may be prescribed, Discontinuing aspirin, aspirin-containing products, trapped in the ear by earphones, earplugs, or hearing depending on the severity of the condition. Swim- and NSAIDs often reverses the ototoxic effects of aids can contribute to infective otitis externa. Explain mer’s ear tends to recur and can become chronic for why sharing of objects that are placed in the ear may those with repeated exposure to water as in swimming. cause infective otitis externa. Prognosis Prognosis is positive with treatment. Swimmer’s ear Swimmer’s Ear has a tendency to recur with subsequent exposure Description to water during swimming or other water-related Inflammation and resulting infection of the outer ear activities. canal after water has been entrapped during swim- ming is termed swimmer’s ear. Prevention Preventive measures include keeping the ear clean and ICD-9-CM Code 380.12 (Acute swimmer’s dry. Ear plugs may be used during water activities and ear) ICD-10-CM Code H60.339 (Swimmer’s swimming. Thorough drying of the ear canal after ear, unspecified ear) exposure to water is important. A diagnostic code used in the (H60.331-H60.339 = 4 codes of specificity) Patient Teaching health-care setting has been Impacted cerumen Provide the patient or family with pictures of the anatomy of the ear. Demonstrate how moisture in Figure 5-20 Symptoms and Signs assigned to each disease entity in Impacted cerumen. (From Sigler B: Ear, Figure 5-21 Irrigation of the ear for impacted cerumen. the ear can contribute to swimmer’s ear. Encourage nose, and throat disorders—Mosby’s clinical nursing series, Irrigation of the ear also is Similar to infectious used to remove foreign otitis bodies.externa, severe pain; a red, compliance with any drug therapy prescribed. St Louis, 1994, Mosby.) this publication to help students swollen ear canal; hearing loss; fever; and pruritus are common symptoms of swimmer’s ear. Any drainage Otitis Media from the ear may be either watery or purulent. Typi- and workers in the health-care cally, the onset of the condition occurs after the Description patient has been swimming. Otitis media is inflammation of the normally air-filled setting understand the ICD-9-CM/ middle ear with the accumulation of fluid behind the Patient Screening tympanic membrane (eardrum), occurring either uni- ICD-10-CM coding process when Individuals reporting pain in the ear accompanied by laterally or bilaterally. drainage require prompt attention. reporting clinical information. Etiology ICD-9-CM Code 381.4 (Nonsuppurative otitis media, not specified as either acute or chronic) Accumulation of cerumen in the ear canal when 382.0 (Suppurative and mixed with water, as during swimming, acts as a unspecified otitis media) culture medium for bacteria or fungi. (Requires fifth digit) Extensive Supplemental Resources A Patient Screening section guides students in the Student Workbook practice of appointment scheduling or specialist referral based on a patient’s described signs and The workbook features comprehensive additional symptoms. review exercises and practice activities in a variety of A Patient Teaching section guides students in the formats to reinforce chapter topics. practice of performing patient education for Word Definitions and Glossary Terms review various diseases and disorders. important key terms covered in each chapter. Essay questions invite students to further investi- Short Answer and Fill-in-the-Blank questions gate key chapter topics. review key chapter concepts. A Certification Exam Review helps students An Anatomical Structures section in select chap- prepare for the certification exam with questions ters presents diagrams representing key body struc- focused on chapter content in multiple choice tures to be labeled by the student. format. xvi Preface thinking questions, and time estimates for the Evolve classroom lecture and activities. Corresponding The specially designed complementary Evolve website PowerPoint slides are provided to help the instruc- provides important assets to students and instructors. tor save valuable preparation time and create a For students, critical thinking case study exercises learning environment that fully engages the linked to each chapter can be found on the Evolve student. website, available for access at http://evolve.elsevier Assessment Plan—To ensure that your students.com/Frazier/essentials/. have mastered all the objectives, the new TEACH includes a separate “Assessment Plan” section. An easy-to-use table maps each assessment tool to the Test Bank lesson plans and chapter objectives so you can see The test bank located on the Evolve site in the Exam- all your assessment options—by chapter, by lesson, View format gives instructors the option of evaluating and by objective—and choose accordingly. students’ retained knowledge by chapter in a compre- Answer Keys to the text and workbook hensive format. This tool is capable of assessing reten- All the above features are available to the instructor tion of essential information necessary for excellence for easy download from the Evolve site, allowing the in functioning in the workplace. The sixth edition test instructor to apply his or her creativity; all of these bank has been updated and revised to now include features may be revised to accommodate any instruc- answer rationales. tor’s lesson plan. TEACH Instructor Resources Important Information The TEACH Instructor Resources have been com- The information presented in this book represents pletely updated and revised for this edition. The research into the mainstream of medical knowledge TEACH lesson plans help instructors prepare for class and its application in clinical practice. In the actual and make full use of the rich array of ancillaries and practice of the dynamic art and science of medicine, resources that come with the textbook. The content great variations and opposing views result in either covered in each textbook chapter is divided across one more conservative or more aggressive concepts. The or more lesson plans, each designed to occupy 50 material presented in this text should not take the minutes of class time. Lesson plans are organized into place of individualized consultation with medical easily understandable sections that are each tied to the experts. chapter learning objectives: Regarding the diagnostic codes included in this pub- Instructor Preparation—This section provides a lication, it is imperative to consider the following: checklist of all the things you need to do to prepare Medical coding is an intricate and intense process for class, including a list of all the items that you requiring study and understanding to ensure maximum need to bring to class to perform any activity or reimbursement from insurance companies, for partici- demonstration included in the lesson plan, and all pation in Medicare and Medicaid programs, and for pertinent key terms covered in that lesson. statistical tabulation. Diagnostic codes are subject to Student Preparation - Textbook readings, study changes, revisions, and additions; therefore it is imper- guide exercises, online activities and other appli- ative that you always refer to a current listing of ICD- cable homework assignments for each lesson are 9-CM/ICD-10-CM codes. The authors have kept in provided here along with an overall estimated com- mind that financial reimbursement directly correlates pletion time. with the reporting of current, valid codes, which may The 50-Minute Lesson Plan—A lecture outline require modification to ensure greatest specificity that reflects the chapter lecture slides that come as found in the most current coding manual and guide- part of TEACH is included, as well as classroom lines. Therefore the authors recommend referral to a activities and online activities, one or more critical current edition of a coding manual.  Preface xvii Regarding patient teaching, the authors are mindful Students completing education in medical assisting of legal parameters addressed in state acts governing will find this book an invaluable tool as they move the practice of medical assistants. Readers, please into the professional arena. It has been designed to consult your state code regarding licensing for the rules provide information relevant in the medical office and regulations applying to medical assistant practice. environment and will remain a handy reference during State practice laws vary; they identify the tasks the employment. The website updates will offer a resource properly prepared medical assistant can perform. covering current changes in the health-care field to Regarding the responsibility issue, the medical assis- help keep the graduate current. tant in a medical office must know who his or her The established health-care provider, whether a supervisor is; it may be the physician. Medical assis- medical assistant, nurse, transcriber, coder, respiratory tants should ask about a written office policy regarding therapist, massage therapist, receptionist, EMT, para- any delegation of tasks by the physician, physician medic, pharmacy technician, or other, will find this assistant, nurse practitioner, or registered nurse. reference material a valuable resource in his or her The authors consider it important, and in the work with the patient. Knowledge of the disease and patient’s best interest, that all health-care workers as its related factors is essential in the provision of members of a clinical team understand the principles, quality care. goals, and specifics of patient teaching. Licensing regu- lations and state practice acts generally permit only Margaret Schell Frazier, RN, CMA (AAMA), BS nurses, nurse practitioners, physician assistants, and phy- Jeanette Wist Drzymkowski, RN, BS sicians to perform patient teaching and make triage judgments. This page intentionally left blank Contents 1 Mechanisms of Disease, Diagnosis, and 10 Diseases and Conditions of the Treatment, 1 Circulatory System, 493 2 Developmental, Congenital, and 11 Diseases and Conditions of the Urinary Childhood Diseases and Disorders, 40 System, 582 3 Immunologic Diseases and 12 Diseases and Conditions of the Conditions, 130 Reproductive System, 618 4 Diseases and Conditions of the 13 Neurologic Diseases and Endocrine System, 174 Conditions, 690 5 Diseases and Disorders of the Eye 14 Mental Disorders, 743 and Ear, 210 15 Disorders and Conditions Resulting 6 Diseases and Conditions of the from Trauma, 804 Integumentary System, 263 Appendix I Common Laboratory and 7 Diseases and Conditions of the Diagnostic Tests, 861 Musculoskeletal System, 312 Appendix II Pharmacology, 886 8 Diseases and Conditions of the Glossary, 911 Digestive System, 362 Index, 922 9 Diseases and Conditions of the Respiratory System, 442 xix This page intentionally left blank