Law And Ethics For Medical Assistants Study Guide PDF

​ Chapters 3 & 4 ○​ Everything Law And Ethics For Medical Assistants -​ Ethics is one of those intangible elements of life we deal with daily. Balancing patient confidentiality with public safety: - Patient confidentiality is crucial. - Public’s right to know about dangerous situa...

​ Chapters 3 & 4 ○​ Everything Law And Ethics For Medical Assistants -​ Ethics is one of those intangible elements of life we deal with daily. Balancing patient confidentiality with public safety: - Patient confidentiality is crucial. - Public’s right to know about dangerous situations. - The law provides tools and frameworks for addressing these issues. Judging provider performance: - The law provides standards and guidelines. - Obligated to follow societal rules for individuals or public interest. Awareness of legal requirements: - Medical assistants need to be aware of relevant laws. - Not expected to know all legal specifics but should understand basic legal requirements. Understanding ethics: - Ethics involves daily intangible elements. - Ethical dilemmas occur when two moral principles conflict. - Right behavior may sometimes lead to wrong outcomes. Distinguishing between law and ethics: - Law: what it is, who makes it, criminal vs. civil law, liability insurance types. - Ethics: professional, organizational, and personal ethics. - Differentiating ethical and moral judgments. Common Law: - Developed through court decisions and judicial rulings. - Based on precedents set by previous cases. - Evolves over time as new decisions are made. State Law: - Enacted by state legislatures and applied within a specific state. - Covers areas such as criminal law, family law, and property law. - Can vary significantly from one state to another. Federal Law: - Enacted by the United States Congress and applies across all states. - Covers areas such as immigration, bankruptcy, and civil rights. - Takes precedence over state law in case of conflicts. Arbitration: - A process where a neutral third party (the arbitrator) makes a binding decision. - Often used in commercial disputes. - Usually faster and less formal than court proceedings. Mediation: - A process where a neutral third party (the mediator) helps the disputing parties reach a mutual agreement. - The mediator doesn't make decisions; they facilitate communication. - Often used in family, workplace, and community disputes. - Legal liability is the legal accountability for one’s acts or omissions. Medical Malpractice: - Occurs when a doctor fails to exercise appropriate care for a patient. - Means "bad practice" in Latin. - Defines any medical treatment that falls short of normal skill, care, or established procedure. Malpractice Insurance (Errors and Omissions Coverage): - Covers errors and omissions made in the standard course of medical care. - Does not provide coverage for criminal behavior. - Also known as professional liability insurance. Employer-Provided Coverage: - Some employers provide professional liability insurance for medical assisting staff. - Others may not, requiring purchase from an insurance broker. Personal Liability Insurance (Comprehensive Personal Liability, CPL): - Found in homeowner’s, auto, and umbrella policies. - Provides financial protection for bodily injury or property damage sustained by others for which you are responsible. - Think of it as protection for you and your family. Criminal law: - Exclusively statutory. - Deals with acts prohibited by law or failures to perform required acts. The defendant is the person on trial; the plaintiff is the government (prosecution). - Two types of crimes: misdemeanors (punishable by less than one year in jail or fines) and felonies (punishable by more than one year in state prison or death). - Standard of proof: beyond a reasonable doubt. - Example: O. J. Simpson case (found not guilty in criminal court due to reasonable doubt). Civil law: - Collection of statutes and case law governing the conduct and affairs of people and entities. - Infractions are not crimes. - Standard of proof: preponderance of the evidence (lower standard than reasonable doubt). - Example: O. J. Simpson's wrongful death action (found liable in civil court). Misdemeanors: - Less severe crimes. - Punishable by less than one year in jail, fines, or both. - Examples include petty theft, minor assault, and vandalism. - Often handled in local or municipal courts. - May result in probation or community service instead of jail time. Felonies: - More severe crimes. - Punishable by more than one year in state prison or even death. - Examples include murder, rape, and armed robbery. - Handled in state or federal courts. - Can result in significant jail time, fines, and long-term consequences like loss of voting rights. Torts are a branch of common law, derived from the Latin term "tortum," meaning "wrong." - Examples of torts: are automobile accidents, product liability, slander and libel, and medical malpractice. - Tort law allows the harmed person to sue the wrongdoer for compensatory and punitive damages. - Torts can be unintentional (e.g., automobile accidents, a baseball through a window, a rock from a lawnmower) or intentional (e.g., libel and slander, trespass, intentional infliction of emotional distress). - Defamation of character includes both libel (written) and slander (spoken). - Slander example: Saying “Dr. Jones is an awful provider; he’s killed at least a dozen of his patients” could lead to liability if the statement is untrue and causes damage. - Libel example: Posting a similar defamatory statement on Facebook or a blog. Negligence is a failure to exercise the care that a reasonably prudent person would exercise in like circumstances. - It involves harm caused by carelessness, not intentional harm. - Key elements of negligence: Duty: The defendant owed a legal duty to the plaintiff. - Breach: The defendant breached that duty by acting or failing to act. - Causation: The defendant's actions (or inaction) caused the plaintiff's injury. Damages: The plaintiff suffered actual harm or injury. - Examples include car accidents caused by distracted driving, medical malpractice, and slip-and-fall incidents. Standard of care refers to the level of caution and attention expected of a reasonable person in similar circumstances. - It's used to determine if someone's actions were negligent. - The standard can vary depending on the situation and the person's role (e.g., a doctor vs. a regular person). - In medical cases, it’s based on what a competent healthcare provider would do in a similar scenario. - If someone fails to meet this standard, they might be found negligent. Defenses to medical malpractice -​ Statute of limitations: This tells all who would file a lawsuit that they have a limited period in which to bring their claim. - In the case of medical malpractice, an injured patient generally has two years from the date the injury is discovered in which to file their lawsuit - The statute in some cases does not start running until the plaintiff reasonably knows about the negligence or when the plaintiff has not reached the age of legal majority. - Contributory negligence: an action by the plaintiff has contributed to the injury they have suffered. - When the plaintiff does something that has contributed to their injury, the provider cannot be blamed ​ Immune Chp 14 ○​ Table 14-1 Combining Definition Example Form aden/o Gland Lymphadenopathy is often found with viral illnesses such as infectious mononucleosis. lymph/o Lymph Lymphoma is a tumor found in the lymph system. lymphaden/o Lymph Nodes Structures of the lymphatic/immune system where pathogens and harmful substances are filtered from the lymph by specialized cells of the immune system. myel/o Bone Marrow Produces lymphocytes (type of white blood cell). splen/o Spleen When a person’s spleen becomes overactive and removes too many blood cells, splenectomy, and removal of the spleen, might have to be performed. Thym/o Thymus A specialized primary lymphoid organ of the lymphatic/immune system. ○​ Function and structures of the lymphatic system ​ The main function of the immune system is to protect the body against outside invaders. The immune system creates effective immune responses to continually defend the body against antigens. Known as the first line of defense against disease It plays an essential role in the immune functions of the body Lymph- composed of blood plasma that filters out the capillaries, lymphocytes, hormones, and other substances that are the product of cellular activities. -​ Also referred to as intracellular or interstitial fluid -​ Acts as the ¨ bridges¨ between cells and capillaries Lymph vessels- located throughout the body -​ Lymphatic capillaries absorb fluid and other substances from the tissues and return them to the circulatory system. -​ One-way system only Lymph nodes- are small, round, or oval structures located usually in clusters along the lymph vessels at various places in the body. ○​ Adenitis In acute infections, they become swollen and tender because of the collection of cells gathered to destroy the invading substances. This condition is known as adenitis. With extensive involvement, the node may break down, and an abscess will form. ○​ How do lymph nodes relate to cancer? With malignancy, the cancer cells are abnormal and so are identified by the cells in the lymph node to be removed from the circulating fluid. As more cells accumulate, the node becomes enlarged and is therefore palpable. Early detection of lymph node involvement is critical to the prognosis of patients with cancer, for it is through the lymphatic system that a malignancy often metastasizes (spreads) to other sites. The extent of lymph node involvement is an important indicator of the ultimate prognosis of the patient. ○​ Antigens and antibodies difference ​ Antigens are things that the immune system recognizes as nonself and responds to by destroying or rendering them ineffective. ​ ANTIBODIES are a dual response system involving the actions of specific cells and other immune system components to attack the antigen. Antigens are the harmful molecules or pathogens that trigger an immune response. Antibodies are the immune system's defense agents that specifically target and neutralize these antigens. ○​ Where do RBCs mature Erythrocytes (RBCs) develop from erythroid stem cells and mature in the bone marrow. ○​ Where do WBCs mature White blood cells (WBCs), which become the granulated eosinophils, neutrophils, and basophils, develop from myeloid stem cells. One type of agranulocyte, the lymphocyte, develops from a lymphocyte stem cell into two major classes: B cells that mature in the bone marrow and T cells that mature in the thymus. ○​ T Cells/ B Cells The B cell represents about 20 percent of the lymphocytes. They act upon their targets by producing antibodies in a process called humoral immunity. When B cells are maturing, they go through two stages of development, in the forest begins with the cell inserting numerous molecules of one specific kind of antibody and only one specific antigen can activate it. Helper T Cells - Helper T cells produce proteins called lymphokines that help other lymphocytes and phagocytes perform their functions. They also help B lymphocytes make antibodies. Helper T cells are identifiable by the CD4+ cell marker. HIV affects the function of the helper T cells, and the severity of the disease is measured by the CD4+ blood counts. Killer T Cells - Killer T cells can directly kill infected or malignant cells and those cells carrying a target antigen. They are also known as cytotoxic T cells and carry the CD8+ cell marker. One type of killer T cell can attach tightly to its target and secrete perforin and other chemicals, which make holes in the target cell’s membrane, destroying it before it can reproduce. Unfortunately, killer T cells will also attack the nonself-marker cells of transplant tissues and organs, causing rejection. Memory T Cells - Memory T cells have a memory from a previous experience with specific antigens and so are prepared to act immediately upon recontact. Suppressor T Cells - Suppressor T cells stop or turn off the actions of the T cells when the “battle” is under control. ○​ Immunoglobulins (Ex. IgB IgM) 1.​ IgA- Concentrated in body fluids, such as tears, saliva, and respiratory and gastrointestinal secretions, to guard the entrances of the body 2.​ IgD- Located on B cell membranes. Believed to regulate B cell activity 3.​ IgE- Very effective against parasites but also involved in allergic responses, such as hay fever, asthma, and urticaria 4.​ IgG- The most plentiful antibody, it coats microorganisms in the tissues to speed up the uptake by other immune system cells. It carries out both antibacterial and antiviral activity. It can cross the placental barrier. 5.​ IgM- Found in the bloodstream and very effective in killing bacteria. It is responsible for the initial formation of antibodies once exposed to an antigen. ○​ Active and passive immunity Active immunity: vaccines are given in initial and in “booster” doses to provide memory cells and antibodies for longer periods. The recipients make their immunity. Passive Immunity: given to people who are already exposed to a disease, such as tetanus. Antibodies from another source are injected into the person to provide temporary immunity to counter the immediate attack of pathogens. The immunity is short-lived. ○​ AIDs/HIV ​ origin, The AIDS epidemic is primarily prevalent in sub-Saharan Africa, with Zimbabwe having a 15% prevalence. It impacts the workforce, families, and orphans. HIV-1 is the main type, with HIV-2 being more common in western Africa and India. Testing is limited to those living in countries with HIV-2 prevalence. ​ Symptoms Early Signs and late sign Early signs and symptoms- Many people who are infected with the virus do not have any symptoms when first infected. Within a month or two after exposure, however, they may have a flu-like illness that includes headache, fever, fatigue, and enlarged lymph nodes. The symptoms usually subside within a week. During this flu-like period, HIV is present in high concentrations in genital fluids, and infected persons are highly contagious. Later signs and symptoms- Severe symptoms of HIV infection may not appear for 10 or more years in adults and two or more years in children. However, during this asymptomatic period, the infected person is still capable of passing on the virus, and the T helper cells are being systematically destroyed. The numbers decline (as measured by the CD4 [T4] counts) and infections and other symptoms begin to occur, such as: Enlarged lymph nodes Fatigue Pelvic inflammatory disease Fever, sweats Weight loss Yeast infections Rashes, dry skin Short-term memory loss Late signs and symptoms of AIDS —The signs and symptoms of AIDS are related to the effects of infections ​ Treatment HIV and AIDS are treated using various medications. Nucleoside reverse transcriptase inhibitors (NRTIs) slow HIV replication by incorporating it into the DNA, while non-nucleoside reverse transcription inhibitors (NNRTIs) prevent replication by inhibiting viral proteins. Protease inhibitors interrupt virus replication at a later stage, while fusion inhibitors prevent HIV from entering healthy T cells. Highly active antiretroviral therapy (HAART) combines reverse transcriptase and protease inhibitors, reducing AIDS deaths by almost half in the US. HIV vaccines are being developed to induce antibodies against different strain  ​ the first case in the U.S The beginning of AIDS in the United States is well documented. Between October 1980 and May 1981, five young, previously healthy homosexual men were treated for pneumonia caused by Pneumocystis carini. ​ the body system affected by AIDS ​ Circulatory ​ Integumentary ​ Respiratory ​ Nervous ​ Type of pneumonia( Pneumocystis carinii) Pneumocystis carinii pneumonia is indicated by a fever, cough, and difficulty breathing; by Kaposi's sarcoma, 2 forms of cancer appearing as purplish blotches on the skin; by candidiasis, a yeast infection that is sometimes present in the mouth, esophagus, and vagina, and by the usual infections. There are over 20 opportunis-ic infections that people with AIDS may experience, such as other forms of pneumonia, meningitis, encephalitis, esophagitis, persistent diarrhea, and skin inflammation. These are often resistant to treatment. About 60 percent of AIDS patients have neurologic symptoms, including motor problems, inability to concentrate, memory loss, and progressive mental deterioration. They are believed to be caused by brain infection or cancer. ​ Kaposi Sarcoma 1.​ Early HIV infection: Often has no signs or symptoms, detectable only by a blood test, urine test, or saliva test. 2.​ Blood tests for HIV detection: Detects antigens found on the virus or antibodies made against HIV. 3.​ Antibodies: These may not be detectable for 1 to 4 months, up to 6 months for enough antibodies to be present for a positive test. 4.​ Types of HIV tests: 5.​ Antibody tests: Most common, including ELISA, EIA, and Rapid HIV tests. 6.​ Western blot: Used to confirm a positive result from antibody tests (to avoid false positives). 7.​ Antigen tests: Less commonly used, performed on blood samples, detect HIV 1 to 3 weeks after exposure. 8.​ Fourth-generation algorithm: Combines antibody/antigen immunoassay to identify both HIV-1 and HIV-2, enhancing early detection. 9.​ Home testing: 10.​ OraQuick In-Home HIV test: Uses oral swab, results in about 20 minutes. 11.​ Home Access HIV-1 Test System: Blood sample collection, sent to a lab for testing (not a true HIV test kit). 12.​ HIV viral load monitoring: Used to predict the risk of HIV progressing to AIDS, as higher virus levels correlate with increased risk of progression to AIDS and related infections or death  ○​ Difference between Benign and Malignant Tumor Benign tumors are usually slow-growing, do not invade other tissues, and do not spread to other parts of the body. Usually, they do not cause any problems unless they are growing in a confined space, such as in the brain. Malignant tumors are cancerous and differ from benign in several ways: ​ Cancer cells have an altered cell structure that includes an increased nuclear size, irregular chromatin distribution, and prominent nucleoli. ​ Cancer cells lack normal growth-controlling mechanisms; growth is unorganized and disorderly. ​ Cancer cells lack contact inhibition (normal cell growth stops when other cells are contacted). They continue to grow and invade other tissues. ​ Cancer cells do not respond to growth factors that stimulate or inhibit the growth of normal cells. They can grow rapidly with reduced growth factors. ​ Cancer cells frequently escape immune surveillance. ​ Cancer cells are invasive, destroying normal tissue. ​ Cancer cells can metastasize by traveling through the lymphatic or blood vessels implanting into other body sites and creating additional tumors. ​ Cancer cells have an increased metabolic rate. ○​ Classification of cancers Cancer can be classified according to its cellular origin. Cancers arising from epithelial tissues are known as carcinomas, whereas those from connective tissues are called sarcomas. Cancers of the blood and blood-forming organs are called leukemias, and those from the lymph tissue are lymphomas. Cancers can also be described according to their degree of differentiation. This refers to how similar the cancer cell appears to the normal cell from which it was derived. A well-differentiated cancer cell looks similar to a normal cell, and a poorly or undifferentiated cancer cell appears very abnormal. Sometimes it is so poorly differentiated that it is difficult to tell from what type of cell it originated; these cancers are termed “carcinomas of unknown primary.” Grading refers to the degree of differentiation of the cancer cell. The grading system goes from Grade 1, which is a well-differentiated cell, to Grade III or IV, which is undifferentiated. The grading and staging findings predict prognosis. ○​ Lupus ​ S/Sx of Lupus - ​ fever ​ weight loss ​ headache ​ fatigue ​ swollen glands ​ depression ​ loss of appetite  ​ nausea and vomiting ​ easy bruising ​ hair loss ​ edema Suggestive signs of lupus include: ​ a rash over the cheeks and bridge of the nose ​ rashes developing after being in the sun ​ arthritis in two or more joints ​ seizures ​ bald spots ​ discoid lupus lesions ​ ulcers inside mouth ​ pleurisy ​ anemia ​ Raynaud’s phenomenon ​ (fingers turn white or blue in the cold) Diagnosis is made from symptoms and blood tests for evidence of autoantibodies. Urine is checked for protein, RBCs, and WBCs. A specific antibody test called ANA (antinuclear antibody) looks for antibodies to the nuclei of cells. Over 99 percent of people with lupus will have a positive test; however, only 33 percent of people with a positive ANA have SLE. ​ Types of Lupus ​ Systemic lupus ( Symptoms, Treatment) Systemic lupus erythematosus (SLE) inflames the organs of the body. Some persons also have skin and joint involvement; in others, diseased lungs, kidneys, or blood may be affected. The disease is characterized by periods of remission, when few if any symptoms are evident, and other periods of active disease and symptoms. ​ Discoid lupus (Symptoms, Treatment) Discoid lupus erythematosus (DLE)-Cutaneous or discoid lupus is confined to the skin and causes a persistent flush of the cheeks or discoid lesions on the face, neck, scalp, and other areas exposed to ultraviolet light. The lesions of the face are referred to as a butterfly rash. The rash is usually scaly and red but not itchy. If not treated, scarring may result, and if on the scalp, bald spots. Treatment- of SLE consists of assuring patients they can live near-normal lives. Limits on activities are dictated by the disease. Patients are encouraged to rest when needed but otherwise engage in normal employment and exercise. Sun exposure should be avoided at peak hours (10:00 a.m. to 2:00 p.m.); otherwise, as tolerated. Sunscreens of at least SPF 15 are advisable. No medication has been developed to cure lupus. Joint and muscle pain is controlled with anti-inflammatory and analgesic drugs, such as aspirin, ibuprofen, and naproxen. During flare-ups or if major organs are involved, steroids, such as prednisone, are often used to suppress inflammation. The steroid also interferes with the proliferation and interaction of the cells in the immune system and causes T cells to gather in the lymph nodes, which removes them from concentrating at the inflammation sites. The drugs chloroquine and Plaquenil (antimalarials) are valuable in managing skin lesions and also help control arthritis symptoms. Many new treatments are being tested, several dealing with self-antigens, immunoreplacement therapy, and even plasmapheresis (the removal of blood plasma, and hence antibodies). It is believed with a further understanding of the immune system, an effective treatment for lupus will be discovered. ​ Chp 15 Digestives ○​ Four phases of the Digestive The digestive process can be divided into four phases: Ingestion- Digestion is the activity performed by the organs of the digestive system, and it is defined as the process by which food is broken down, mechanically and chemically, in the GI tract and converted into an absorbable form that can be used by the cells of the body. Absorption- Elimination- ○​ Digestive system organ function ​ Food enters the body through the mouth. It is held in the oral cavity while the initial digestive process is begun. Teeth break up food into small pieces to make it easier to swallow and also to prepare it for more effective action by digestive enzymes. ​ ○​ How do carbs affect our energy? Carbohydrates supply about two-thirds of the energy calories needed each day. ○​ Where do we get protein? Proteins are obtained primarily from plant and animal sources but are not stored by the body. They must be eaten daily because they are the main ingredients needed to build and repair cells and tissue. ○​ Different types of teeth ​ “Baby” teeth are called deciduous and begin to appear at about six months. They are gradually exchanged for permanent teeth starting at about six years. ​ Different teeth have specific duties to perform. ​ The incisors bite food with their sharp edges. ​ The canines or cuspids are pointed to puncture and tear. ​ The premolars or bicuspids and the molars are for grinding and crushing. ○​ Parts of the small intestine ​ Function The small intestine is a tube about one inch in diameter and about 20 feet long. It completes the digestive process and absorbs the nutrients from the chyme. The small intestine is divided into three sections. The first is a C-shaped segment about nine inches long called the duodenum. Because this area receives the highest concentration of acid from the stomach, it is especially prone to ulcers, which are called duodenal ulcers. The next segment, the jejunum, is about 8 feet in length. The last segment, about 12 feet long, is called the ileum. The jejunum and ileum are suspended in the abdominal cavity by the mesentery, a fan-shaped fold of tissue that is attached to the posterior abdominal wall. The ileum is reduced to about half an inch in diameter by the time it joins the large intestine in the right lower quadrant of the abdomen. The junction is marked by a sphincter called the ileocecal valve, which allows the chyme to enter the cecum (the first segment of the large intestine) but prohibits anything from returning to the ileum. ○​ Liver versus Gallbladder ​ The liver is the largest gland in the body. It lies below the diaphragm in the upper right quadrant of the abdomen, extending into the upper left quadrant. The liver is a vital organ that performs several functions for the body. It secretes bile at a rate of over a pint a day, and the bile is continuously excreted through bile passages to the bile duct. ​ The gallbladder is a small sac attached to the underside of the liver. Its sole purpose is the concentration and storage of bile. When the body needs bile to digest food, the gallbladder releases the concentrated bile to supplement that being currently produced by the liver. ○​ Diagnostic test 1.​ The small intestine is a tube about one inch in diameter and about 20 feet in length. It completes the digestive process and absorbs the nutrients from the chyme. 2.​ The small intestine is divided into three sections. The first is a C-shaped segment, about nine inches long, called the duodenum. Because this area receives the highest concentration of acid from the stomach, it is especially prone to the development of ulcers. An ulcer in this area is called a duodenal ulcer. 3.​ The next segment, the jejunum, is about 8 feet in length. The last segment, about 12 feet long, is called the ileum. The jejunum and ileum are suspended in the abdominal cavity by the mesentery, a fan-shaped fold of tissue that is attached to the posterior abdominal wall. 4.​ The ileum is reduced to about half an inch in diameter by the time it joins the large intestine in the right lower quadrant of the abdomen. The junction is marked by a sphincter called the ileocecal valve, which allows the chyme to enter the cecum (the first segment of the large intestine) but prohibits anything from returning to the ileum. ○​ GI X-Ray Radiologic studies of the GI tract are indicated for a wide variety of reasons and are concerned with the various positions of the system. -​ Barium swallow- If the condition or function of the esophagus is in question, the patient may be asked to drink a radiopaque liquid called barium while the action of the esophagus is  observed by a fluoroscope. This test is known as a barium swallow. It aids in diagnosing conditions such as dysphagia, hiatus hernia, diverticulosis, and varices. It also detects strictures, tumors, ulcers, and functional disorders. The barium swallow is usually included as part of the more complete GI series. Upper Gi series - A barium swallow is performed initially to evaluate the esophagus. Barium is consumed as the progress of the medium is observed by fluoroscope. X-ray films are taken at specific periods to permit further evaluation. The stomach is compressed to ensure that the barium coats the entire lining. As the barium enters the small intestine, the radiologist manipulates the abdomen to obtain distribution of the barium throughout the bowel loops. The patient is rotated to several positions to record pertinent areas. Spot films may be taken at 30- to 60-minute intervals until peristalsis carries the barium to the ileocecal valve. -​ Preparation: An upper GI series is not painful, but the chalky taste and consistency of barium are unpleasant. Preparation for the test may require a two- to three-day diet of low-residue foods before the examination. All oral intake must stop at least eight hours before it is scheduled. The patient must also refrain from smoking. Both a laxative and a cleansing enema may be ordered the evening before the procedure to be certain the tract is empty. -​ Post op- An upper GI series aids in the diagnosis of gastric ulcers, tumors, strictures of the sphincters, inflammation of the lining, motility irregularities, duodenal ulcers, tumors, filling defects, and the like. Following the exam, another laxative may be ordered to aid in the removal of the barium from the intestines. Retained barium may cause constipation, obstruction, or fecal impaction. Colonoscopy- An examination to view the entire large intestine using a flexible fiber-optic scope. It is indicated in patients with complaints of diarrhea, constipation, bleeding, or lower abdominal pain. ❖​ The American Cancer Society recommends a colonoscopy every 10 years, beginning at age 45, as a screening test for colon cancer. -​ Preparation- Starting 24 hours before the examination, the patient is allowed only clear liquids or things that become liquid when eaten, such as gelatin. Patients are not allowed to drink or eat anything red or purple such as grape juice or Jell-O. In addition to the diet, the patient will be instructed to take a variety of laxatives depending on the provider’s preference. Laxatives are repeated until the stool becomes nothing but liquid. Twelve hours before the procedure, nothing can be taken by mouth. -​ During/post-op -The patient is sedated and positioned on the left side, with the scope guided through the large intestine. Air is inserted, abdomen manipulation aids, and repositioning facilitates passage. The scope can obtain tissue samples, cytology studies, and polyps snaring.  ○​ Cirrhosis of the liver - This chronic disease of the liver destroys the liver cells. The destruction leads to impaired blood and lymph circulation and interferes with the life-preserving functions of the liver. S/sx —Early symptoms include a variety of GI tract signs, such as lack of appetite, indigestion, nausea, vomiting, constipation, and diarrhea. Later, nosebleeds, bleeding gums, edema, mental confusion, and anemia may develop. The liver and spleen become enlarged, jaundice is present, and ascites (collection of fluid) occur within the abdomen. Because the disease interferes with portal circulation, hypertension occurs in the portal system, causing esophageal varices that eventually rupture and bleed.Various blood tests support the diagnosis of cirrhosis, but positive confirmation can be obtained through a liver biopsy. A liver scan will detect abnormal thickening and a mass. Etiology—The most frequent cause of cirrhosis is malnutrition associated with alcoholism. Other causative factors are hepatitis or the suppression of bile flow resulting from a disease of the ducts. Treatment—Treatment consists of taking measures to prevent further damage or complications and dealing with the underlying cause. Dietary changes, supplemental vitamins, rest, and appropriate exercise are indicated. Extra care is required when prescribing drugs because the damaged liver may not be able to process them. Alcohol must be prohibited. It is also important to avoid contact with infections. Mortality is high, with many patients dying within five years of diagnosis. ○​ Colorectal cancer- This is a malignancy of the colon or rectum. The American Cancer Society estimated 104,610 new cases of colon cancer and 43,340 new cases of rectal cancer in 2020. It is the third most common cancer in men and women. S/sx —Symptoms can vary in the area involved. With right-side colon involvement, there may be black tarry stools, anemia, abdominal aching, pressure, and dull cramps in the beginning. As the disease progresses, weakness, fatigue, dyspnea, vertigo, and eventually diarrhea, anorexia, weight loss, vomiting, and other signs of intestinal obstruction will occur. There is rectal bleeding, abdominal fullness, cramping, and rectal pressure. Later, there is diarrhea and “ribbon” or pencil-shaped stools. Bright red blood and mucus are in or on the stools. With rectal cancer, the first symptom is a change in bowel habits—often “morning diarrhea” may alternate with obstipation (constipation caused by obstruction). This will be followed by a feeling of incomplete evacuation and later pain and a feeling of rectal fullness. Treatment—The most effective treatment is surgery to remove the tumor, adjacent tissues, and any lymph nodes that may be involved. The type of tumor and extent of involvement determine the surgical procedure. It may involve only the removal of a section of the colon and its supporting structures, total resectioning of the rectum, and the construction of a permanent colostomy. Chemotherapy is indicated with metastasis, residual disease, or a recurring inoperable tumor. Radiation and chemotherapy may be used before surgery to reduce the tumor size and activity and are given following surgery to treat any missed cells. ○​ Colostomy ( when does some need a colostomy ) This is an artificial opening of the colon, allowing fecal material to be excreted from the body through the abdominal wall. A colostomy is also indicated when an obstructive growth process, such as a tumor, prohibits the passage of feces. When the growth is close to the end of the rectum, there may not be enough healthy tissue remaining to which a segment of the colon can be attached. There may also be evidence that removal of the affected area, even if possible, would present no advantage. The colostomy patient has a major emotional adjustment in addition to the physical adjustment to make. The alteration in body image may be difficult to accept. The thought of fecal material being expelled into a pouch attached to the abdomen may be very unappealing. Consider also that there is no control over the expulsion of flatus (gas) or stool, and it is easy to understand the new patient’s rejection. ○​ Diverticulosis- This is the presence of bulging pouches in the wall of the GI tract where the lining has pushed into the surrounding muscle. The sigmoid colon is the most common site, but diverticulitis can occur anywhere from the esophagus to the anus. Signs and Symptoms—Symptoms of diverticulosis (infected diverticula) include irregular bowel movements, lower left abdominal pain, nausea, flatus, low-grade fever, and an increase in WBCs. Chronic diverticulosis may result in fibrosis and adhesions (tissues growing together) that severely limit or obstruct the lumen. Symptoms progress from constipation to ribbon-like stools, diarrhea, distention (swelling up) of the abdomen, nausea, vomiting, pain, and abdominal rigidity. Treatment—initially consists of preventing constipation and combating infection. A liquid diet, antibiotics, one medication to soften the stool, and another medication to relieve pain and relax muscle spasms are called for. When conservative measures fail, the affected colon section may need to be removed. ○​ Gerd- This is a backflow of gastric and sometimes duodenal contents into the esophagus through the sphincter just above the stomach. Signs and Symptoms—The most common feature is heartburn, which becomes more severe with vigorous exercise, bending, or lying down. There may be esophageal spasms that mimic angina pain, radiating to the neck and arms. Reflux may be associated with hiatal hernia. If there is regurgitation of fluids, there may be pulmonary symptoms of aspiration, including nocturnal wheezing, bronchitis, asthma, morning hoarseness, and coughing. Tx- Common treatment includes the use of common antacids, such as Alka-Seltzer, Maalox, Mylanta, Rolaids, Tums, and others. These can work almost immediately after being taken to suppress the symptoms and continue for about three to four hours. Another group of drugs, such as Pepcid AC, are called -blockers. They suppress the secretion in the first place to prevent heartburn. Their effects begin after about an hour but last for several. Perhaps the best treatment is prevention: ​ Avoid or cut back on foods that trigger heartburn (alcohol, chocolate, fat, peppermint, and spearmint); these tend to relax the sphincter.  ​ Avoid caffeine; it stimulates gastric acid (caffeine is found in coffee; strong tea; soda pop; and medications, such as Anacin, Excedrin, and NoDoz). ​ Avoid carbonated drinks, which distend the stomach and increase the pressure. ​ Lose weight if overweight. ​ If a smoker quits. ​ Use gravity (don’t lie down after eating and raise the head of the bed on four- to six-inch blocks at night). Hepatitis Chp 16 Urinary ○​ 3 main Functions of the urinary system ​ The urinary system performs three main functions. The first is excretion, the process of removing waste products and other elements from the blood. The second is secretion, by which urine is produced. The third is elimination, the emptying of the urine from its bladder storage. ​ Table 16-1 ​ Pathway of the urine ○​ When waste products are not removed from the blood, they build up, producing potentially fatal toxicity. After the kidneys have performed their functions, the waste material, urine, is carried through the ureters, one for each kidney, to temporary storage in the bladder. When an adequate amount has been accumulated, the bladder expels the urine through the urethra, eliminating it from the body. ​ Urinary bladder ○​ The bladder, a muscular tissue bag behind the symphysis pubis, serves as a urine reservoir, collecting 250 mL before urination. Its capacity can exceed 1,000 mL, requiring catheterization to relieve distention and discomfort. In cases of retention, urine is removed. ​ Medical terms used to describe urinary output ○​ Other medical terms commonly used to describe urinary output include anuria, an absence of urine ○​ dysuria, pain or discomfort associated with voiding; ○​ hematuria, blood in the urine; ○​ nocturia, having to urinate at night; oliguria, a scanty urinary output; ○​ polyuria, excessive urination. ○​ Descriptive words used to clarify symptoms are dribbling, the involuntary loss of drops of urine; ○​ frequency, the necessity to void often; ○​ hesitancy, difficulty in initiating urination; ○​ urgency, the sudden need to void.  ​ Dialysis ○​ Hemodialysis- a process whereby blood is passed through a thin membrane and exposed to a dialysate solution to remove waste products. ○​ Peritoneal dialysis- Instead of an artificial dialyzer to cleanse the blood, the patient’s peritoneal membrane is used (the peritoneum covers the abdominal organs and lines the abdominal cavity). ○​ AV Fistula- is created by a vascular surgeon who joins an artery and a vein together and makes an opening between the two so that blood flows directly from artery to vein, bypassing the capillaries. This rapid flow of blood can be felt over the fistula and is described as a “buzzing” feeling. Listening with a stethoscope at the fistula, you can hear the blood flow sound, which is called a bruit. A fistula requires about four to six weeks to mature before it can be used. Repeated needle insertions require rotation of sites, but eventually, the fistula will fail and another will need to be made.​ Synthetic Graft- is similar to a fistula except it is made with either a synthetic material or a treated, sterilized animal vein. The graft is inserted when the patient’s blood vessels do not permit a fistula. It joins the artery and the vein and matures for use a little quicker than a fistula. Grafts are at risk for narrowing in the vein near where it is sewn, which causes clotting. Since they are a foreign material, infection becomes a risk. ○​ Permacath- a large double-lumen (two openings) catheter. It can be surgically inserted into either the jugular or subclavian vein to provide temporary access for hemodialysis treatments. The jugular and the subclavian veins. The tubing from the hemodialysis machine connects with the openings of the catheter. The blood exits from the proximal opening on the catheter and goes to the machine for filtering. After being treated through the machine filters, the blood returns through the distal opening of the catheter to the body. The catheter is inserted to provide immediate use of dialysis access to permit hemodialysis. It is often used while waiting for a fistula or a graft to mature. ​ bruit and thrill ○​ Bruit: A bruit is an abnormal sound heard through a stethoscope, typically caused by turbulent blood flow in an artery. It often indicates narrowing (stenosis) or blockage of a blood vessel, which can lead to conditions like atherosclerosis. Bruits are commonly heard over arteries such as the carotid, renal, or femoral arteries. ○​ Thrill: A thrill is a palpable vibration or buzzing sensation felt on the skin over an artery or heart valve. It occurs due to turbulent blood flow, often associated with conditions such as arteriovenous malformations, aneurysms, or valvular heart disease. Thrills are usually detected during a physical exam by gently palpating the area over the vessel or heart. Both signs are important in diagnosing vascular or cardiovascular issues. ​ Kidney transplant  ○​ The transplantation of body organs is always at risk of recipient rejection; however, the kidney can usually be successfully transplanted, and the survival of the graft has been markedly improved by the use of the drug cyclosporine. Transplantation is indicated in cases of prolonged chronic debilitating disease and renal failure involving both kidneys; unfortunately, transplantation often is not performed until patients have been on dialysis for a significant time because of a lack of organ donors. ​ Diagnostic test ○​ Intake and output (I&O) An intake-output measurement involves keeping a record of all fluid, or food that melts to liquid, that is consumed, along with all urine or other fluid loss, be it measured or estimated. For example, emesis would be measured; perspiration estimated as slight, moderate, or profuse; diarrhea indicated as to frequency; and any other loss (such as bleeding, drainage through a stoma, or excessive respiratory activity) evaluated. Hence, intake is compared with output to determine fluid balance within the body. Routine specimen ○​ preferably the first of the morning is simply voided into a clean container. ○​ - Clean Catch specimen: usually for culture purposes, pregnancy determination, or microscopic examination, involves specific cleaning of the meatal area and catching the specimen midstream in a sterile container. ○​ - 24-hour test: collects all urinary output, from a specified hour one day until the same time the next day, in a special container under specific conditions ​ Acute vs Chronic Renal Failure Acute Renal Failure -​ Description—A critical illness, acute renal failure results in the sudden cessation of kidney function. Effective medical treatment usually can overcome the problem. If not, however, it will progress to uremia and death. -​ Signs and Symptoms—Symptoms initially apparent are oliguria and azotemia (nitrogenous products of protein metabolism in the blood). Without filtration, the waste products and excess solutes quickly collect in the blood, resulting in severe electrolyte imbalance, acidosis, and uremia, which interfere with the function of the other body systems. A vast number of other symptoms develop, listed here by body system and in ascending order within the system: -​ Gastrointestinal: anorexia, nausea, vomiting, hematemesis (bloody vomitus) -​ Nervous: headache, drowsiness, confusion, convulsion, coma -​ Integumentary: dryness of the skin, pruritus, pallor, uremic frost (powdery white crystals of urea on the skin) -​ Circulatory: hypotension initially, then hypertension, cardiac rhythm irregularities, CHF, edema, anemia, pulmonary edema -​ Respiratory: Kussmaul’s respirations (fast, deep respirations, over 20 per minute and usually sounding labored, resembling sighs) - Fever and chills, indicators of infection, are an expected complication. Diagnosis of renal failure is confirmed by blood test findings of greatly elevated quantities of urea, nitrogen, and creatinine and by urine samples with casts, protein, and altered specific gravity. Additional verification with diagnostic examinations, such as KUB, IVP, ultrasound, and retrograde pyelography, may be indicated. -​ Etiology—Renal failure may be caused by an obstruction, inadequate circulation, or damage to the nephrons. Failure caused by bilateral obstruction is usually associated with calculi, blood clots, tumors, strictures, or an enlarged prostate. Inadequate blood flow results from low blood pressure and low volume in the arteries, which eliminates the force required for the kidney to filter water and solutes from the blood. This can result from shock, embolism, hemorrhage, loss of fluid caused by burns, congestive heart failure, and arrhythmias. Nephron damage, which may cause failure, can result from acute glomerulonephritis, sickle cell anemia, bilateral renal vein thrombosis, acute pyelonephritis, renal myeloma (tumor), or toxic substances, like medications. -​ Treatment—Treatment consists of a high-calorie diet that is low in protein, sodium, and potassium. Fluids are controlled. Dialysis may be required. Chronic Renal Failure -​ Description—This is a result of the progressive loss of kidney function. -​ Signs and Symptoms—Symptoms do not develop significantly enough to warrant investigation until almost 75 percent of glomerular function is gone. The remaining normal nephrons gradually deteriorate, causing symptoms of renal failure and other system involvement. Signs and symptoms initially are related to an imbalance of sodium and potassium and an accumulation of nitrogen from protein metabolism; these may include hypotension, dry mouth, listlessness, fatigue, and nausea. Later, the patient will begin experiencing mental dullness and confusion. Symptoms increase as more nephrons fail. Additional system involvement is similar to that described with acute failure, but a few specific differences do occur with the slower progressive course. Infertility and amenorrhea (lack of menses) in women, impotence in men, and impaired carbohydrate metabolism also result from improper endocrine action. The skeletal system develops a mineral imbalance that results in bone pain because of parathyroid hormone imbalance. This in turn allows the minerals to be withdrawn from the bones, causing fractures. Calcifications develop in the brain, eyes, joints, myocardium, and blood vessels. Children with chronic failure show stunted growth patterns because of endocrine abnormalities. -​ Diagnosis is made in the same manner as for acute renal failure. -​ Etiology—Chronic renal failure can be the result of many preexisting conditions, such as chronic glomerular disease; chronic infections;  obstructions; stones; and endocrine diseases, such as diabetes, vascular diseases, hypertension, and chronic overdose of toxic agents. -​ Treatment—Treatment is almost exclusively dependent on dialysis to correct the chemical imbalance. Other treatment is required for the complications developed in the other body systems. Long-term dialysis requires specific physical and psychological therapy. Patients must be meticulous in their care. The skin must be clean, and lotions should be applied to combat dryness and itching. Good oral hygiene is a must to alleviate bad breath and counteract excessive dryness and bad taste. Diet is extremely critical and requires individual adjustments about dialysis. Daily records of intake and output will aid in determining fluid status. If urine is not being excreted, fluid builds up within the body’s tissues. Dialysis removes this fluid, causing the patient to express feelings of being “wrung out.” Chp 17 Endocrine ​ Table 17-2 Gland Location Hormone Principal Effects Pituitary The 1.​ Growth hormone ​ Normal growth of body tissues anterior lobe undersurface (GH) ​ Stimulates growth and activity of thyroid cells to of the brain in 2.​ Thyroid-stimulatin produce and secrete thyroid hormone the sella g hormone (TSH) ​ Stimulates the cortex of the adrenal gland and the turcica of the (Thyrotropin) secretion of cortisol skull 3.​ Adrenocorticotropi ​ Increases skin pigmentation c hormone ​ Stimulates the maturity of the Graafian follicle to (ACTH) rupture and to produce estrogen in the female. In 4.​ Melanocyte-stimula the male, it stimulates the development of the testes ting hormone and the production of sperm. (MSH) ​ This causes the development of the corpus luteum, 5.​ Follicle-stimulating which then secretes progesterone in the female. In hormone (FSH) the male, it stimulates the interstitial cells of the 6.​ Luteinizing testes to produce testosterone. hormone (LH) ​ Develops breast tissue and stimulates secretion of 7.​ Prolactin (PR) milk from mammary glands Posterior Oxytocin ​ Stimulates contraction of the uterus, especially Vasopressin or antidiuretic during childbirth; causes the ejection of milk from hormone (ADH) mammary glands ​ Acts on cells of kidney tubules to concentrate urine and conserve fluid in the body; also acts to constrict blood vessels Thyroid The lower Thyroxine and ​ Increase metabolism; influence both physical and portion of the triiodothyronine mental activity; promote normal growth and anterior neck Thyrocalcitonin development ​ Causes calcium to be stored in bones; reduces blood level of calcium Parathyroid The posterior Parathormone Regulates the exchange of calcium between the bones and surface of the blood and increases blood calcium thyroid gland Adrenal The superior Adrenaline (epinephrine) ​ Increases heart rate, blood pressure, and flow of Medulla surface of each Aldosterone (mineral blood; decreases intestinal activity Cortex kidney corticoid) ​ Controls electrolyte balances by regulating the Glucocorticoids reabsorption of sodium and the excretion of Sex hormones (androgens) potassium ​ Affects the metabolism of protein, fat, and glucose, thereby increasing blood sugar; and decreasing inflammation ​ Govern sex characteristics, especially those that are masculine Pancreas Behind the Insulin ​ Essential to the metabolism of carbohydrates; stomach Glucagon reduces the blood sugar level ​ Stimulates the liver to release glycogen and convert it to glucose to increase blood sugar levels Thymus Under the Several peptides React on lymphoid tissue to produce T lymphocyte cells to sternum regulate immunity Pineal Body The third Melatonin Influences onset of puberty and circadian rhythms ventricle in the brain Ovaries Female pelvis Estrogen ​ Promotes growth of primary and secondary sexual Progesterone characteristics ​ Develops excretory portion of mammary glands; aids in maintaining pregnancy Testes Male scrotum Testosterone Develops primary and secondary sexual characteristics; stimulates maturation of sperm ○​ Blood sugar, frequently measured after fasting (fasting blood sugar, FBS)—To assess the function of the pancreas, including insulin effects. ○​ T3, TSH, and T4—To measure the level of the thyroid hormones ○​ Urine human chorionic gonadotropin (HCG) (pregnancy test)—To measure the presence of a hormone secreted by the placental cells  ○​ Glucose tolerance—To measure the body’s ability to process a large dose of glucose. Multiple blood samples are taken at specific intervals following ingestion of the glucose mixture. ○​ Glycohemoglobin or Hemoglobin A1c (Hgb A1c)—A simple blood test that measures how well the glucose level has been controlled over the previous four to six weeks. The glucose attaches to the hemoglobin of the red blood cells (RBC). A1c is the stable molecule formed when sugar and hemoglobin bind together in the RBC in a process called glycosylation. A1c can be measured. An elevated finding indicates poor glucose control. Measuring A1c reveals a truer picture of blood sugar level control than conventional glucose measurement. If the diabetic patient has not been conforming to diet, except in anticipation of an office visit, the cells will reveal that they have picked up excess sugar. Recently, an Hgb A1c of 6.5 percent or more is a criterion for diagnosis of diabetes. ​ Diabetes (Type 1 and Type 2) ​ Figure 17-11 Diabetic Coma (Hyperglycemia) -​ Appears to be in a stupor or coma -​ High blood glucose levels -​ Face flushed -​ Fruity odor to breath -​ Tongue dry -​ Labored, Prolonged respirations -​ B/P Low -​ Weak and rapid pulse -​ Urine positive for sugar and acetone -​ Skin dry Insulin Shock (Hypoglycemia) -​ Excited, nervous, dizzy, confused, irritable, inappropriate responses. -​ Low blood glucose levels -​ Headache -​ Face Pale -​ Shallow or rapid respirations -​ B/P normal -​ Full and pounding pulse -​ Urine Negative for sugar and acetone -​ Skin moist-excessive perspiration -​ Lack of coordination, trembling. Metformin is a common medication used for diabetics.