Corps School I

Hospital Corps School Table of Contents
Handbook 1
TABLE OF CONTENTS

Foreword........................................................................................................................................................i

Tips for Success............................................................................................................................................1

1.01 Basic Life Support ..........................................................................................................................9
Basic Life Support Worksheet.......................................................................................................11

1.03 Role of the Hospital Corps.............................................................................................................19
Role of the Hospital Corps Worksheet ..........................................................................................25

1.04 Introduction to the Bureau of Medicine and Surgery (BUMED)...................................................29
Introduction to the Bureau of Medicine and Surgery Worksheet..................................................33

1.07 Basic Medical Terminology and Abbreviations............................................................................35
Basic Medical Terminology and Abbreviations Worksheet..........................................................41

1.08 Anatomy and Physiology: Total Man............................................................................................45
Anatomy and Physiology: Total Man Worksheet..........................................................................51

1.13 Anatomy and Physiology: The Cardiovascular System.................................................................55
Anatomy and Physiology: The Cardiovascular System Worksheet...............................................69

1.14 Anatomy and Physiology: The Respiratory System......................................................................77
Anatomy and Physiology: The Respiratory System Worksheet....................................................83

1.18 Customer Service and Interpersonal Communication....................................................................85

1.10 Anatomy and Physiology: The Musculoskeletal System.............................................................107
Anatomy and Physiology: The Musculoskeletal System Worksheet...........................................123

1.09 Anatomy and Physiology: The Integumentary System................................................................129
Anatomy and Physiology: The Integumentary System Worksheet.............................................131

1.11 Anatomy and Physiology: The Nervous System.........................................................................133
Anatomy and Physiology: The Nervous System Worksheet.......................................................139

1.21 Vital Signs....................................................................................................................................143
Vital Signs Worksheet.................................................................................................................155

1.12 Anatomy and Physiology: The Eye and Ear................................................................................159
Anatomy and Physiology: The Eye and Ear Worksheet..............................................................165

1.05 The Law of Armed Conflict.........................................................................................................169
The Law of Armed Conflict Worksheet.......................................................................................175

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Table of Contents Hospital Corps School
Handbook 1
1.06 Basic Medical Ethics....................................................................................................................179
Basic Medical Ethics Worksheet.................................................................................................189

1.17 Anatomy and Physiology: The Genitourinary System.................................................................193
Anatomy and Physiology: The Genitourinary System Worksheet..............................................201

1.02 Basic Mathematics.......................................................................................................................205
Basic Mathematics Worksheet.....................................................................................................213

1.15 Anatomy and Physiology: The Lymphatic System......................................................................221
Anatomy and Physiology: The Lymphatic System Worksheet...................................................223

1.16 Anatomy and Physiology: The Digestive System........................................................................225
Anatomy and Physiology: The Digestive System Worksheet.....................................................229

1.19 Patient Interviewing and History Taking Techniques..................................................................233
Patient Interviewing and History Taking Techniques Worksheet...............................................237

1.20 Principles and Concepts of Medical Asepsis...............................................................................239
Principles and Concepts of Medical Asepsis Worksheet.............................................................245

1.22 Preventive Medicine..............................................................................................See Handbook III
Preventive Medicine Worksheet............................................................................See Handbook III

1.23 DOD Immunization Program.................................................................................See Handbook III
DOD Immunization Program Worksheet ..............................................................See Handbook III

1.24 Managed Care Concepts.........................................................................................See Handbook II
Managed Care Concepts Worksheet.......................................................................See Handbook II

1.25 Health Promotion Program.....................................................................................See Handbook II
Health Promotion Worksheet..................................................................................See Handbook II

Appendix 1 A-1-1

Appendix 2 A-2-1

Appendix 3 A-3-1

iv

FOREWORD

MISSION OF NAVAL HOSPITAL CORPS SCHOOL

To train Sailors to perform as basic Navy Hospital Corpsmen.

The Student Handbook series was written to be used in the fourteen-week curriculum of the Basic Hospital
Corps School. There are three Handbooks in the series:

Handbook I - Fundamentals

Handbook II - Emergency Care

Handbook III - Nursing Care

The Student Handbooks contain reading and study material to supplement the classroom lectures and
demonstrations conducted during the course. Each topic in the course has a section in one of the Handbooks.
The text is followed by a Worksheet, which provides study questions based on the learning objectives. The
Worksheet questions are similar to those on the written examinations.

Tips for Success, eight pages of study techniques, test taking strategies, and suggestions for time
management follow the Foreword in Handbook I.

The Student Handbooks are best used to read and prepare for upcoming classroom lectures, to re-read and
fill-in the worksheet assignments and finally, re-reading as many times as necessary in preparation for written
examinations and laboratory performance.

Students who keep their Handbooks after graduation will find them to be an excellent study guide for
advancement examinations and an outstanding reference during future duty assignments.

Study smart or study hard, the choice is yours.

Naval Hospital Corps School is accredited by the Council on Occupational Education

Basic Hospital Corps School TIPS FOR SUCCESS
Handbook 1
TIPS FOR SUCCESS

HOW TO STUDY AND SUCCEED!

If you use the following suggestions, you will
notice an improvement in your ability to study and
learn. If you REMAIN FIRM IN YOUR DESIRE
TO LEARN more effectively, you will be
rewarded not only with better grades, but with a
better adjustment to life as well. It is important to
SETTLE DOWN AND STUDY WITH A
PURPOSE. Learning is evidenced by a change in
behavior. Learning may be regarded as a
progressive organization of behavior. Some
individuals think there is a magic button to be
pushed which will disclose short cuts to learning
and success. THERE IS NO MAGIC BUTTON!

A GOOD STUDENT:

- has a strong desire to succeed in school.

- actively listens and participates during
class: if necessary, forcing oneself to be
active.

- sees the value of each subject.

- asks questions in class, and goes to the
instructor for clarification if something is
not understood.

- has a study schedule which specifies the
time allotted for each subject.

- consistently uses some technique to
organize the material and own thoughts.

- uses spare time to review important
points.

- avoids daydreaming.

TO BE A GOOD LISTENER:

Study the assignment before the lecture.

Be ready to learn before the instructor starts the
lecture.

Listen for clues (voice inflection, emphasis, key
words, etc.) Skip unnecessary words and don't
worry about grammar. Develop the habit of
listening with the intention of taking good notes.

STUDY TECHNIQUES

P A T Method:

Previewing - Skim quickly through the
assignment, read the objectives, they tell you
what to learn. If there are questions with the
material, look them over quickly.

Attacking - Read actively. Use a technique to
fix the material in your mind. Underline, mark
margin notes, outline, whatever method works
best for you.

Testing - Ask yourself questions or have a
friend ask you questions which may appear on
the exam. Do the daily reading assignments.
Write your own questions and study them.
Reread the parts of the material which the
questioning has shown that you do not
understand. Ask your instructors for
clarification. Answer all questions on the test.

Study-Rest-Study Method: This method is useful
for long study periods. It is quite effective in
helping you absorb the material to be learned.
Study for about 40-45 minutes, then take a 10
minute break. Quickly review the previous
material before starting again.

Question and Answer Sessions: This study
technique involves writing a question on one side
of a 3 x 5 card and the answer on the other side.
Ask yourself the question, then flip the card over
to the answer. This method can be used anywhere,
anytime, by carrying the cards in your pocket. This
is a great learning aid.

1
Mnemonics: Learning by association. This
technique was used extensively by the ancient
Romans and Greeks. Associate something simple
and familiar with something that is new. Create
interesting words or phrases to stimulate your
memory. An example, which you will see later is:

HN S. CASPER to help remember the order for
primary and secondary assessment. It means:

H head C chest

N neck A abdomen

S shoulders S spine

P pelvis

E extremities

R recheck vital signs

Additional hints: Manage YOUR time wisely.
Set aside a certain time each day to study and
STICK TO IT! You should study about two hours
per day as a minimum, more if you find this is not
adequate. Study EACH and every day. You will
fall behind if you skip your study sessions. DO
NOT CRAM! Trying to cram the night before an
exam does not work. You often end up more
confused than knowledgeable.

NOTE: If you are not satisfied with your progress,
ask your Class Advisor for assistance. Assistance
is available in the form of 1 to 1 tutoring. If you
think you are having trouble . . . ASK FOR HELP!

TIPS FOR IMPROVED LISTENING
SKILLS

The primary mode of instruction is the
classroom lecture. It is each student's
responsibility to listen carefully to the lectures and
take notes on what is discussed.

This section will review listening AND ways
in which it can be enhanced. Listening is an active
process. To listen well, your mind must be active.
You must think, synthesize, and evaluate
constantly. This means focusing attention on the
topic at all times. Allowing the mind to wander,
even for a few minutes, can cause you to miss
vital, testable information! Active listening can
lead to accurate and improved note taking and
success in your life.

STEPS FOR LISTENING

Prepare to listen. Learn as much as possible
about the topic before the lecture. Complete all
reading and homework assignments before
class.

Avoid Classroom Distractions. Be attentive
to the instructor. Block out extraneous noise
and movement. Do not permit yourself to
become a distraction. Keep your noise and
movement to a minimum.

Look and Listen for Main Ideas. In order to
take good notes, it is necessary to know the
main ideas of the lecture. The instructor may
highlight main ideas by:

Introducing them with key phrases, such
as:

Take this down

Write this down

Remember this

The most important thing is

Listen closely

You will hear/see this again

When the instructor uses a key phrase, place a
mark in the margin of your notebook, so that you
will remember to study this material more
carefully.

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Handbook 1
Repeating material: The instructor may
use the same words or repeat information
using different phrasing. Again, if this
occurs, place a special mark in the margin
of your notebook. Using physical actions
to call attention to a point: Actions such as
tapping the chalkboard or using a pointer
for emphasis, are clues to listen more
carefully.

While Listening, Take Notes.

Notes are a good source of review because
they:

Will contain important information needed
for examinations and labs.

Are a condensed version of the material.
You may not have enough time to reread
your entire text prior to the exam.

Notes must be well organized in order to
be effective as a study tool. They should
contain:

The main idea.

The expected outcome (learning
objectives).

Key points.

Specific words, names, terminology, dates,
and/or other important information.

Unfamiliar words and terms. Circle these
words and look up their definitions later.

COMPLETE TEXT The vertebrae are named according to the
section of the spine in which they lie.
The spinal column is the central supporting
Structure of the body. It is composed of 33
Bones, called vertebrae. The spine is divided
Into five sections.

1. Cervical (neck)

2. Thoracic (upper part of back)

3. Lumbar (lower part of back)

4. Sacral (part of pelvis)

5. Coccygeal (coccyx or tail bone)
FIGURE T1
3
TIPS FOR SUCCESS Basic Hospital Corps School
Handbook 1

Eliminate unnecessary words while
retaining all important information.
Figures T1 and T2 provide samples of
note-taking techniques. In Figure T1 the
complete text is on the left. The note on
the right is brief, but adequate for review.

Many students find the method of note taking
in Figure T2 very useful. Draw an imaginary line
down the left side of the page, 2 inches from the
margin. To the left of this line, write a key word,
phrase, or objective. To the right of this line,
write the facts which apply to the topic. Then skip
a line and repeat.

This method permits rapid note taking
without worry about outline form. This method is
also useful when studying. Cover the right side of
the page and quiz yourself. Do you know the
supporting facts or ideas related to the topic?

Abbreviate as much as possible. The
following list is a sample of abbreviations. You
will learn many more during the lesson on
Medical Terminology. As you learn new
abbreviations utilize them in your note taking!

C =with

NSS =Normal Saline solution

tx =treatment

Classification and causes 1. Open Wound disrupts skin penetrates
Thoracic wall and internal organs.

Open Cause Object passing through chest wall.

Example Bullets, knives, fragments.

Closed 2. Closed No disruption of skin. Force
transmitted to S.C. tissues.

Cause Blow to thorax.

Example hitting steering wheel during car
accident

FIGURE T2

s =without

sx =symptoms

H20 =water

IM =intramuscular

S.C. =subcutaneous

Review and Revise Lecture Notes Within 24
Hours. Reviewing and revising will help:

Clear up points of misunderstanding.

Add information missed during lecture.

Organize the material.

Fix the material firmly in your mind.

Once satisfied with the completeness of your
notes, it may be helpful to rewrite them. If notes
were taken from the reading assignments,
consolidate the two sets of notes. This effort will
further help the learning process. In summary,
obtaining the most from a lecture necessitates
advance preparation (review of assigned
readings), attentive listening, careful note taking,
and review/revision of notes within 24 hours.

WORKSHEETS. The worksheets were
prepared to aid students in selfstudy and
4
Handbook 1
homework. These sections correspond with
the classroom lectures and the written
information. If used as an aid, after the
reading assignments, the worksheets should
be helpful in preparing for written
examinations and laboratory performance.
Enabling objectives for each topic are on the
workbook pages. Written tests, skill
performance laboratories, and didactic lessons
are based on the enabling objectives.
Instructors may make worksheets mandatory.
Correct answers should be reviewed prior to
examinations and labs by an instructor or
EPO. The worksheets are a supplement to the
lectures and laboratories. In no way is it a
replacement for note taking in the classroom
or the practical laboratories.

PRACTICE AND TEST AND
EVALUATION LABORATORIES

Skills that are important for a basic Hospital
Corpsman to know and understand are taught first
in a classroom setting and then demonstrated
either in that same setting or in the lab
environment. Critical skills will be practiced in a
Practical Lab, and also tested in a Test and
Evaluation Lab. You will perform some skills on
fellow students; and have an opportunity to let
other sudents perform their skills on you.

Practical laboratories are supervised
environments in which students practice. Steps
for each skill are outlined on Practical Laboratory
Performance Checklists. These are used by
students and instructors as reinforcement of
classroom learning, and in preparation for
evaluation in Testing and Evaluation
Laboratories.

Test and Evaluation labs are utilized to assess
each students knowledge and ability to perform
identified skills. Testing and Evaluation
Performance Checklists are distributed by the
instructor.

When scheduled for a Practical or Test and
Evaluation Lab, enter your name, class number,
etc., on the form immediately prior to each lab.
You are NOT expected to perform the skills
during Practice Labs flawlessly, but you are
expected to know and understand why the skill
should be performed and be able to safely
demonstrate (for the victim and yourself) the skill
with some ability. Performance and knowledge
standards are higher in Test and Evaluation Labs.

How to learn a skill:

Pay attention during class when the skill is
explained or a movie is shown and during the
demonstration.

Review the skill performance checklist,
paying special attention to the * steps. These steps
have greater importance in performing the skill
and will assist in your learning the skill.

Close your eyes and imagine yourself
performing the skill.

Practice performing the skill in groups of
three students. One student will be the do'er, one
the victim, and the third will follow the lab sheet
to verify correctness.

Many of the skills can be practiced by
simulating equipment, pillows or stuffed animals
for victims, pens for penlights, etc. If this is not
possible, some equipment may be checked out IF
the EPO communicates your need to the Class
Advisors.

ADDITIONAL HINTS:

If you are not confident in your ability to do a
skill, you will make errors. Practice in practical
lab, at night study, and on your own.

If you are nervous when some one is
watching you perform a skill, concentrate on the
patient. Imagine that the patient is someone close
to you. Take a DEEP BREATH and RELAX if
you feel yourself getting tense.

WRITTEN EXAMINATIONS

The best way to pass an exam is to know the
subject matter.

5
Handbook 1
Before the exam:

Review all through the week, not just
before the exam!

Enter the exam well rested. Don't lose
sleep just before exam time.

Prepare and take short exams of items
you expect to be on the exam. (See Study
and Succeed section). After studying,
have a classmate quiz you on the
material. This will give you a good idea
how well you know the material. These
quizzes help build confidence and are a
useful review procedure.

Exam time:

Get yourself ready to take the exam. FIRST
OF ALL, RELAX !

Listen to and follow the directions of the
exam proctor. If you have any questions about
procedures or directions, ask the proctor
BEFORE the exam starts. Ignore distractions, and
focus your attention on the exam. Distractions can
come from outside or within you.

DISTRACTIONS FROM OUTSIDE:
There will always be some noise and
movement around you as you take an
exam. If you find this noise and
movement distracting, try using your
mind like the tool that it is. You can
direct yourself, your movements and your
thoughts if you really want to. Direct your
attention to your immediate objective, the
exam.

DISTRACTIONS FROM WITHIN:
Many people have a fear of exams.
However, since you were able to score
high enough on your entrance
examinations to enter the Navy, you have
already proven yourself able to take and
pass exams. If you prepare yourself
thoroughly for each exam, you have
every reason to be confident in your
ability to take and pass the exam.

Taking the exam:

Students should plan to go through each test
at least twice. The first time through you should
read each question and answer those you know,
leaving the more difficult ones. Then you should
go through the test a second time to answer those
you passed up. Be careful to answer the question
asked, not your own formulation of the question.
Read all the possible answers before selecting
your answer. There can be more than one correct
answer to a question, but one will be more correct
than the others because it contains more exact, or
additional, information.

TO ANSWER A DIFFICULT
QUESTION:

Read the question carefully to
understand what is being asked.

Read ALL of the possible answers.

Eliminate those answers you know
are wrong.

Concentrate on the remaining
answers.

Choose the answer that you think or
feel best answers the question.

DO NOT CHANGE an answers unless
you are certain you have made an error.
Your first impressions are correct more
often than they are incorrect.

WATCH FOR IMPORTANT KEY
WORDS AND PHRASES. These key
words or phrases should set off a warning
light to read the question very carefully to
understand what is being asked:

GENERALIZE: a generalization is an
all inclusive, blanket statement. Some
examples are: J uniors ALWAYS
salute seniors. ALL Navy ships are
painted gray. A sailor must NEVER
leave his place of duty.

6
Handbook 1
QUALIFY: qualification limits,
restricts or admits an exception.
Some examples are: All of the
following EXCEPT two are examples
of . . . All BUT the Commanding
Officer must . . . The following action
will be taken only IF it is necessary.

Remember, there is a lot of difference
between which of the following is
true and which of the following is
NOT true?

USE IMPRESSIONS, FEELINGS AND
HUNCHES (WHEN NECESSARY):
During your lifetime you have learned
much that is stored in the far corners of
your mind. Sometimes this knowledge is
not readily available for you to speak or
write, but often is the basis of your
feelings or hunches. When you come to a
difficult question, use all the hints in this
guide. If you have still not arrived at a
satisfactory answer, GO WITH YOUR
FEELINGS!

TAKE YOUR TIME: Use all the time
allotted to take the exam. YOU ARE
NOT going to get an award for being the
first one finished.

NEVER LEAVE A QUESTION
UNANSWERED. A blind guess will be
correct 20-25% of the time. An
unanswered question will be incorrect
100% of the time.

PROOFREAD YOUR ANSWERS IF
YOU HAVE TIME.

Reread the questions to make sure
you understood them correctly.

Make sure you marked the answer
you intended for each question.

Check your answer sheet and make
sure each question is answered and
that there is only ONE answer
marked for each question.
ALWAYS KEEP IN MIND THE BEST
WAY TO PASS AN EXAM IS TO
KNOW THE SUBJ ECT MATTER!

FINAL TOUCHES

In the previous pages, suggestions on how to
be successful in this school have been given. Not
everyone will need all this information, but it is
available if you do! At this point, you may well
be asking yourself and others, how in the world
am I supposed to cram all this into every day for
the next 14 weeks! The last thing that will be
shared is a method for organizing a week. You
may need to adapt this for your personal use.

SUNDAY:

2 hours study in early afternoon

LIBERTY

Night Study or CAMIS 2-3 hours

MONDAY THROUGH FRIDAY

Prior to class, field day berthing area

0630-1600: Scheduled class time

1630-1730: Rewrite notes

1730-1830: Chow

1900-2100: Rewrite notes, complete worksheet
assignments, CRC/outline reading, Finish
anything due next day, read the next day's lesson.
STUDY FOR TESTS

2100-2200: Clean room (FIELD DAY), uniform,
letters, shower, TV

2200: TAPS

FRIDAY AFTER 1600:

Rewrite notes until 1730.

LIBERTY

SATURDAY:

Three hours study in morning
7
Handbook 1
Help other students. ADDITIONAL HINTS FOR SUCCESS

Remember your job is to learn as much as
you can and become a Hospital Corpsman!
2200 TAPS - DO NOT study after taps. This
will help keep your brain awake and ready the
next day!
Instructors and students have worked together
to make this chapter worthwhile. These
suggestions should allow you to establish a
plan to make your time at Hospital Corps
School successful and enjoyable. Any
experience is as good or as bad as YOU make
It!!!

Eat breakfast. It has been said, breakfast is the
most important meal of the day.

Eat a light lunch. Otherwise your body will
become sluggish and you will have difficulty
staying awake or performing lab skills in the
afternoon.

NOTES/COMMENTS
8
Basic Hospital Corps School Lesson 1.01 Basic Life Support
Handbook 1

Lesson 1.01

Basic Life Support

Terminal Objective:

Instructional statement: Basic Cardiac Life Support training is taught using the American Heart
Association certification course for healthcare providers.

Learning Goals:

1. Discuss BLS in perspective.

2. Label the components of the heart and respiratory systems.

3. List Controllable and Uncontrollable Risk factors and be able to discuss Prudent Heart Living.

4. List five signs and symptoms of a heart attack and state actions to take for a heart attack victim.

5. State when cardiopulmonary arrest is not cardiac in origin.

6. Define the purpose of the Good Samaritan Law and safety considerations involved in BLS.

7. Discuss Pediatric Emergencies.

8. Demonstrate Adult, Child, and Infant CPR.

9. Demonstrate clearing a FBAO on the Adult, Child, and Infant.

HOMEWORK:

Read: Basic Life Support for HEALTHCARE PROVIDERS pp 1-1 to 9-12
9
Lesson 1.01 Basic Life Support Basic Hospital Corps School
Handbook 1
NOTES/COMMENTS
10
Handbook I Worksheet
Lesson 1.01

Basic Life Support Worksheet

1. While at work in a hospital, you find an adult victim who has collapsed. No one is available to help. After
you ensure that the scene is safe, what should you do next?

a. Check for unresponsiveness; if the victim is unresponsive, activate the emergency
response system (or phone 911) and get the AED if available
b. Phone 911 (or activate the emergency response system), then wait outside to direct the
emergency responders
c. Open the airway with a tongue-jaw lift and perform 2 finger sweeps to check if food is
blocking the airway
d. Perform CPR for 1 minute, then phone 911

2 You work with an overweight 55-year-old dentist with no known history of heart disease. He begins to
complain of sudden, severe, "crushing" pain under his breastbone, in the center of his chest. The pain has
lasted more than 5 minutes. What problem should you think of right away, and what should you do?

a. Heartburn; tell him to take an antacid
b. Angina; phone his personal physician
c. Heart attack; phone 911
d. Arrhythmia; drive him to an Emergency Department

3. List the four elements of the cardiac care chain of survival.

ADULT Child

a. ________________________________ _______________________________

b. ________________________________ _______________________________

c. ________________________________ _______________________________

d. ________________________________ _______________________________

4. You witnessed the collapse of a 45-year-old man. You are now performing CPR after sending someone to
phone 911. You have done your best to ensure that the first 2 links in the Chain of Survival have been
completed immediately. What is the third link in the chain, which will have the greatest effect on increasing
this man's chance of survival?

a. Arrival of paramedics who will administer drugs
b. Transportation of the man to a hospital
c. Arrival of a rescuer with a defibrillator
d. Arrival of EMS personnel who can do CPR
11
Worksheet Handbook I

5. List three contributing factors to coronary heart disease that can be controlled to reduce the likelihood of
experiencing the disease.

a. _______________________________________________________________________________

b. _______________________________________________________________________________

c. _______________________________________________________________________________

6. You have been talking with a 60-year-old man. He is alert and has been conversing normally. All at once
he complains of a sudden weakness on one side of his face and in one arm. He is also having trouble
speaking. What is the most likely cause of his problem?

a. A seizure
b. A heart attack
c. A stroke
d. Diabetic coma

7. You remove a 3-year-old from the bottom of the shallow end of a swimming pool. You find that she is
limp and unresponsive. No other person is available to help. When should you phone 911?

a. After you have given the child 1 minute of CPR
b. As soon as you remove the child from the pool
c. When you see that after several minutes of CPR there is no response
d. After giving a few ventilations and before beginning chest compressions

8. During CPR, where is the pulse checked on a child?________________________________________

9. During CPR, where is the pulse checked on an infant?_______________________________________

10. You are a medical advisor helping set up a public access defibrillation (PAD) program at a local shopping
mall. The mall has purchased an AED. The mall personnel director asks, If AEDs are so foolproof,' why do
the security guards have to learn CPR and be trained to use the AED? Which of the following is the best
explanation for the need to train rescuers to perform CPR and use an AED?

a. Rescuers don't need to learn CPR if they can use an AED
b. Rescuers need to be able to verify the rhythm analyzed by the AED
c. Rescuers need to know when and how to use the AED safely and to perform the steps
of CPR for unresponsive victims who are not in cardiac arrest
d. Rescuers will need to learn to maintain the AED and repair it if something goes wrong

11. How many compressions in a minute are to be administered during child CPR? __________________

12. What is the ratio for compressions to ventilations when performing two-rescuer adult CPR? _________

13. What is the depth of chest compressions when performing adult CPR? __________________________
12

14. You are responding to an emergency call for a child who was found unresponsive in her bed with no sign
of trauma. How should you open her airway?

a. Place your fingers in her mouth and pull forward on the lower jaw
b. Do the jaw-thrust maneuver
c. Tilt her head and lift her chin
d. Pull her tongue forward

15. List six signs and symptoms of a heart attack.

a. _______________________________________________________________________________

b. _______________________________________________________________________________

c. _______________________________________________________________________________

d. _______________________________________________________________________________

e. _______________________________________________________________________________

f. _______________________________________________________________________________

16. Before providing rescue breathing for an unresponsive victim, you must check for breathing. You do
this by listening and feeling for airflow through the victim's nose or mouth and by

a. Looking into the victim's mouth to see if anything is blocking the airway
b. Shaking or tapping the victims shoulder to stimulate him to breathe.
c. Checking the pupils
d. Looking to see if the chest rises (and falls) as the victim breathes.

17. What is the depth of chest compressions when performing child CPR? _________________________

18. Healthcare providers are cautioned to look for "adequate" breathing when they open the airway and
check for breathing in an unresponsive victim. What is the best explanation for the requirement that the
healthcare provider look for more than just the presence or absence of breathing?

a. Healthcare providers often mistake effective breaths for absence of breaths and they
start rescue breathing unnecessarily
b. Most adult victims of cardiac arrest actually stop breathing before the cardiac arrest,
and the respiratory arrest precipitates the cardiac arrest
c. Many victims of sudden cardiac arrest actually have a foreign body in the airway, which
will require that you check and confirm that breathing is adequate
d. Some victims may continue to demonstrate agonal or gasping breaths for several
minutes after a cardiac arrest, but these breaths and breaths that are too slow or too
shallow will not maintain oxygenation
13

19. You are in the hospital cafeteria, where a woman appears to be in distress. She is grasping her throat
with both hands. What should you do to find out if she is choking?

a. Give her 5 back blows
b. Give her 5 abdominal thrusts
c. Ask her "Are you choking?" and look for any response
d. Shake her and shout "Are you OK?"

20. When beginning CPR, if a ventilation does not go in, what should be done before attempting to
administer another ventilation? _____________________________________________________________

22. You are providing rescue breathing for a child using a bag-mask device. What action will confirm that
each of your rescue breaths is adequate?

a. Determining the child's weight, calculating the tidal volume, and delivering that amount
of air
b. Observing the child's chest rise with each rescue breath
c. Choosing the correct size bag-mask device, which will ensure delivery of adequate
rescue breaths
d. Delivering breaths quickly with high peak inspiratory pressures

23 A 3-year-old child is eating in the hospital playroom. She suddenly begins coughing repeatedly. Her
cough then quickly becomes soft and weak. She is making high-pitched noises while breathing in and seems
to be in respiratory distress. Her skin is a bluish color. What is the most likely cause of her distress?

a. An acute asthma attack causing a swelling of the airway
b. Severe or complete airway obstruction with inadequate air exchange
c. Infected and swollen vocal cords
d. A seizure from a possible head injury

24. What is the ratio for compressions to ventilations when performing CPR on a pediatric patient?
________________________________________________

25. You are performing rescue breathing with a bag-mask device and oxygen for a nonbreathing child with
signs of circulation. How often should you provide rescue breaths for the child?

a. Approximately once every 3 seconds (20 breaths per minute)
b. Approximately once every 4 seconds (15 breaths per minute)
c. Approximately once every 5 seconds (10 to 12 breaths per minute)
d. Approximately once every 10 seconds (6 breaths per minute)

26. For a pediatric patient, how many cycles of CPR are performed before rechecking the
pulse? _________________________________________________
14

27. You are performing 2-rescuer CPR. You are positioned at the victim's head. When you initially open the
unresponsive victim's airway and find that he is not breathing adequately, how many initial breaths should
you give?

a. 1
b. 2
c. 3
d. 4

28. You are at your grandmother's house. Your grandmother is unresponsive and has stopped breathing.
You are giving her mouth-to-mouth breathing. Which of the following statements is the best explanation for
the positive effects of rescue breaths?

a. Rescue breaths help overcome any airway obstruction that may be blocking the airway
b. Rescue breaths will maintain a normal arterial oxygen content
c. Rescue breathing might help defibrillate the heart
d. Rescue breaths are a quick, effective way to provide oxygen to the victim

29. What is proper hand placement for compressions during adult CPR?

______________________________________________________________________________________

30. A 52-year-old man collapses at the fitness center after a workout. To determine whether he is in cardiac
arrest, you should check for signs of circulation. Part of this assessment is the pulse check. What is the
preferred site for a pulse check in this adult victim?

a. At the radial artery of the wrist
b. At the brachial artery of the arm
c. At the carotid artery of the neck
d. On the chest over the heart

31. Where should you place your hands on the chest of a victim when you are performing chest
compressions?

a. On the top half of the breastbone
b. Over the heart, on the left side of the chest at the nipple line
c. Over the very bottom of the breastbone, on the xiphoid
d. On the lower half of the breastbone, at the nipple line in the center of the chest

32. You are performing CPR on an unresponsive man who was found in his bed. What is your ratio of
compressions to ventilations?

a. 15 compressions, then 2 ventilations
b. 5 compressions, then 1 ventilation
c. 10 compressions, then 2 ventilations
d. 15 compressions, then 5 ventilations
15

33. What is the correct rate to perform compressions on adult victim of cardiac arrest?

a. A rate of 60 times per minute
b. A rate of 80 times per minute
c. A rate of 100 times per minute
d. A rate of 120 times per minute

34. A neighbor runs to you with his limp 5-year-old child. You verify that the child is unresponsive and
send the neighbor to phone 911. You open the child's airway, determine that he is not breathing, and deliver
2 effective rescue breaths. You check for signs of circulation and find that the child has no signs of
circulation (including no pulse). Which of the following choices best describes the technique you should use
to perform chest compressions on this child?

a. Use both hands, one on top of the other
b. Use the heel of one hand
c. Use the tips of 2 fingers
d. Use the palm and fingers of one hand

35. You and a colleague have responded to a 911 call to attempt resuscitation of an unresponsive man who
was found in a chair. After laying the victim supine on a hard surface, you open the airway and check for
breathing. When you find no normal breathing you deliver 2 effective breaths. Next you check for signs of
circulation and find no signs of circulation. What should you and your partner do next?

a. Attach an AED (if available) or begin chest compressions and cycles of compressions
and ventilations
b. Deliver 5 abdominal thrusts
c. Check for signs of circulation again
d. Reposition the airway and attempt rescue breaths

36. What is proper finger placement for chest compressions during infant CPR?

_____________________________________________________________________________________

37. You are alone when you see a man collapse. You confirm that he is unresponsive and phone the
emergency response number. There is no AED in sight. You return to the man and perform the steps of
CPR. You open the airway and find that he has only agonal respirations. You deliver 2 effective breaths and
check for signs of circulation. There are no signs of circulation, so you begin chest compressions. When
should you recheck for signs of circulation?

a. After each compression-ventilation cycle
b. After the first compression-ventilation cycle
c. After about 5 minutes of CPR
d. After the first 4 cycles of 15 compressions and 2 ventilations and every few minutes
thereafter

38. The most common cause of cardiac arrest in infants and children is ___________________________ .
16

39. Which of the following most accurately characterizes when you should start chest compressions?

a. As soon as you find that there are no signs of circulation
b. After you have reassessed the victim's breathing
c. After giving the 2 initial ventilations
d. Whenever you find an unresponsive person

40. If you are alone, how long do you perform resuscitative measures on a pediatric patient before leaving to
activate EMS? _________________________________________________________________________

41. When you perform CPR, how do your chest compressions and rescue breathing help the victim of sudden
cardiac arrest?

a. CPR decreases the need for coronary artery bypass
b. CPR forces the heart in ventricular fibrillation to return to a normal heart rhythm
c. CPR has no effect on survival
d. Immediate CPR provides a flow of oxygen-rich blood to the heart and brain and "buys
time" until defibrillation

42. List six signs or symptoms of acute stroke.

a. _______________________________________________________________________________

b. _______________________________________________________________________________

c. _______________________________________________________________________________

d. _______________________________________________________________________________

e. _______________________________________________________________________________

f. _______________________________________________________________________________

43. What is the depth of chest compressions when performing infant CPR ?________________________

44. A 7-year-old boy is struck by a car in front of your house. You find him unresponsive and bleeding
from a wound on his forehead. How should you open his airway?

a. By tilting his head and lifting his chin
b. J aw thrust with cervical spine immobilization
c. By sweeping out his mouth and pulling forward on his tongue
17

45. List five major risk factors for stoke that are controllable.

a. _______________________________________________________________________________

b. _______________________________________________________________________________

c. _______________________________________________________________________________

d. _______________________________________________________________________________

e. _______________________________________________________________________________

18
Basic Hospital Corps School Lesson 1.03 Role of the Hospital Corps
Handbook 1

Lesson 1.03

Role of the Hospital Corps

Terminal Objective:

1.03 State the role of the Hospital Corpsman past and present in Navy medicine.

Enabling Objectives:

1.03.01 State the mission of the Hospital Corps.

1.03.02 State historical events and traditions that shaped the Hospital Corps of Today.

1.03.03 List the Honors and Awards received by Hospital Corpsman in selected conflicts.

1.03.04 List selected roles of Hospital Corpsmen at Naval Hospitals, Naval Clinics, Surface
Ships, Fleet Marine Force, Hospital Ships and Fleet Hospitals.

The mission statement of the Hospital Corps is:

Hospital Corpsman today and in the future
must be well trained and educated in order to
meet the mission of Navy medicine. They must be
trained to a level of clinical competence in order
to fulfill their duties in our medical treatment
facilities aboard ships, with the Fleet Marine
Force, and other operational units. They must be
educated as to why tasks must be done in order to
build their confidence. Corpsmen must be ready
to defend this great nation at a moment's notice.
Therefore, it is incumbent upon them to ensure
they utilize the training they have received and to
reinforce their training whenever and wherever
possible. The performance of duty by Hospital
Corpsmen must be predicated on the Navy's Core
Values of HONOR, COURAGE, and
COMMITMENT.

This mission addresses two very important
concepts upon which the framework or
foundation of the Hospital Corps is built;
competence and accountability. First, the Hospital
Corpsman must be trained and educated to
perform health care duties and skills with at least
a minimal level of competence. Not only must
they be able to perform the skills, but they must
learn why they carry out these health care duties.
In learning what is behind the job they do, they
are learning the very important job of proper
decision-making processes. At the same time they
are building self-confidence so they will be able
to, at a moment's notice, defend this great nation.

Secondly, Hospital Corpsmen must be
accountable. They are to utilize the training they
receive, reinforce the training wherever possible,
and ensure that their performance is well
documented. The Hospital Corpsman
demonstrates accountability by living the Navy's
Core Values, ensuring Honor, Courage, and
Commitment are deeply entwined with their
everyday life.

Origin and Development of the
Hospital Corps

From the very beginning of the Navy, it was
necessary to make provision of the care of the
sick and injured. In 1799, an act of Congress
provided that: A convenient place shall be set
apart for the sick and the injured men, to which
they are to be removed, and some of the crew
shall be appointed to attend them.
19
Lesson 1.03 Role of the Hospital Corps Basic Hospital Corps School
Handbook 1

The convenient place assigned on the ship
was designated as the cockpit. The cockpit was
usually located in the forward part of the ship and
below the water line to protect from shot and
shell. Years later the cockpit became known as
the sickbay, because of the rounded shape of the
recess, or bay.

The1798 roster of the USS Constitution refers
to a loblolly boy who was to serve the surgeon
and the surgeon's mate. The loblolly boy was
responsible for keeping cleanliness about the
cockpit, ringing a bell at 0900 to announce
sickcall daily and preparing the cockpit before
battle. He also provided the cockpit with water,
containers for amputated limbs, and braziers of
charcoal for heating tar with which to stop
hemorrhage. He was also responsible for
providing buckets of sand to catch blood on the
decks so the surgeon would not slip while
working.

In 1843, after the Bureau of Medicine and
Surgery was established, the surgeon's steward
apparently replaced the loblolly boy. The
surgeon's steward was required to meet certain
standards for appointment. Among the
requirements for selection were knowledge of
pharmacy, demonstration of industrious and
temperate behavior, and appointment to the
position by the ship's surgeon. This position was
ranked immediately under the Master At Arms,
and was historically the first of the enlisted
medical personnel required to have specific
qualifications. When selected for the position by
the ship's surgeon, he would earn $18 per month
and one extra ration. A ration was either food or
rum. Surgeon's stewards were never to be
discharged without the consent of the officer
appointing them or their successor, except by
sentence of courts--martial (U.S. Navy
Regulations, 1865).

In 1863, the Navy Department created the
position of male nurse on board ships. Male
nurses were assigned proportionate to the
numbers of the crew. Three years later (1866) the
surgeon's steward was changed to Apothecary.

The position of Apothecary was filled by
personnel who were appointed for duty in the
Medical department of the Navy, by a medical
officer or ship's surgeon. Ashore or afloat
positions were available. Candidates qualifying
for appointment were required to meet stringent
criteria. To qualify for first enlistment,
apothecaries had to be graduates of some
recognized college of pharmacy, pass an
examination, and be between the age of 21 and 28
years.

In 1873 the title of male nurse was changed to
bayman. The bayman was now a member of the
surgeon's division. The other members of the
division were the junior officers, and the
apothecary. Prior to service on a seagoing ship,
baymen were required to attend a course of
instruction on board the receiving ship or at a
Naval Hospital. The bayman's primary duty,
designated in 1893 by U. S. Navy regulations,
was as personal attendant of the sick.

The Establishment of the Hospital
Corps

The Hospital Corps came into existence as an
organized unit of the Medical Department by an
act of Congress approved on 17 J une 1898. This
act provided for appointment to the warrant rank
of Pharmacist and established ratings for:
a) Hospital Steward, (Chief Petty Officer)
b) Hospital Apprentice First Class (Third
Class Petty Officer),
c) Hospital Apprentice.
Under this act, the Secretary of the Navy
appointed 25 senior apothecaries as pharmacists,
who became known as the charter members of the
Hospital Corps. The dean of the charter members
was Cornelius O'Leary, who was credited, at the
date of appointment, with 37 years of service as
an apothecary.
Historical records indicate that the first formal
Hospital Corps School was located at Portsmouth,
Va. The first class graduated on 15 December
1902. The two schools that exist today are located
in Great Lakes, IL and San Diego, CA. Hospital
Corps School, Great Lakes was established in
March 1917. The first class consisted of 20
Hospital Apprentices, though by mid-J une 1917
20
Handbook 1

there were 700 Hospital Apprentices enrolled as a
result of World War I. Hospital Corps School,
San Diego, was established in 1928 and moved to
Balboa Park in 1942.

On 29 August 1916, in the middle of World
War I, the Hospital Corps was reorganized by
Congress, resulting in a restructured strength of
the Hospital Corps. Part of the reorganization
required that 3.5% of the enlisted total strength
of the Navy and Marine Corps would be Hospital
Corpsman. This act established medical enlisted
ratings as follows:

Chief Pharmacist

Pharmacist's Mate First Class

Pharmacist's Mate Second Class

Pharmacist's Mate Third Class

Hospital Apprentice First Class

Hospital Apprentice Second Class

Between World War I and World War II, the
Hospital Corps built a reputation as one of the
outstanding corps of the military services. In fact,
it is the only enlisted corps in the Navy. During
this period, additional qualifications for
advancement were added.

Organizational Changes

Between 1944 and 1948, the Navy Medical
Department responded to social changes brought
about by World War II. The following seven
changes took place.

(1) Prior to the end of WWII, women were
brought into the Hospital Corps. In 1944,
the first Hospital Corps School for
Women Accepted for Volunteer
Emergency Service (WAVES) was
commissioned at the U. S. Naval Medical
Center, in Bethesda, Maryland. The first
class consisted of 230 enlisted women.

(2) Public Law 625 of the Eightieth Congress
in 1948, made WAVES an integral part of
the Regular Navy.

(3) In 1948 the nomenclature of the Hospital
Corps ratings were changed to:

Chief Hospital Corpsman

Hospital Corpsman First Class

Hospital Corpsman Second Class

Hospital Corpsman Third Class

Hospitalman

Hospital Apprentice

Hospital Recruit

(4) In J une 1956, the Warrant and
Commissioned Warrant Officers of the Hospital
Corps were redesignated as Medical Service
Warrant and Chief Medical Service Warrant.

(5) Due to international confusion regarding
which personnel were wearing the device or
insignia of the Red Cross, (the Red Cross depicts
those individuals rendering medical, nursing, and
other humanitarian care) the Navy Medical
Department changed the device for Hospital
Corpsman from the Red Cross to the Caduceus.
Caduceus comes from Greek mythology. The
caduceus is a winged staff with two serpents
twined around it, which was carried by Hermes
(the god of commerce and invention).

(6) In 1948, the Dental Corps made
significant progress in delineating their own
force. Until that time, there was no distinction
made between Hospital Corpsmen working in a
medical-surgical setting, and Hospital Corpsmen
working in the dental setting. A change in the
rating structure of the enlisted Dental Corps was
implemented, and the rating system for all Dental
Technicians was established. The superimposed
over the caduceus, became the new insignia for
the Dental Corps.

21
Handbook 1
(7) In 1948, the Dental Corps also
restructured the ranking of the Medical Service
Corps Officers serving in dental settings. Medical
Service Warrant, Chief Medical Service Warrant,
and Medical Service Corps Officers qualified in,
and assigned to dental settings, were billeted to
perform administrative and technical duties in
dental activities.
(8) Also in 1948, WAVES augmented to the
regular Navy.
(9) The rating of Senior Chief and Master
Chief were established in late 1950.

Hospital Corpsmen in Battle

There is a tremendous historical tradition of
Hospital Corpsman in battle. Hospital Corpsmen
have been examples of HONOR, COURAGE,
and COMMITMENT. This Corps has pride and
respect unsurpassed by any other corps. The
heroic and meritorious accomplishments have
been well documented through the years by Naval
leaders and historians. Let us take a few moments
to look at some major historical periods and
reflect upon some significantly important facts.

The Boxer Rebellion is when the first hospital
corpsman received a Medal of Honor. That
person was Hospital Apprentice Robert Stanley.
He received the medal for distinguished conduct
in the presence of the enemy in volunteering and
carrying messages under fire at Peking, China, 12
J uly 1900.
Between 1900 and World War I, three
Hospital Corpsmen were awarded the Medal of
Honor.
World War I - Secretary of the Navy, and later
Secretary of Defense, J ames Forestall paid honor
to the Hospital Corps for its singular attainments
during World War I. As far as can be determined,
this is the first time in military history that a
single corps has been commended by the
Secretary of the Navy.

During World War I, ten Chief Pharmacists
were promoted to the rank of Lieutenant in the
Medical Corps. At that time there were 94
temporary commissioned officers and 16,000
enlisted men in the Hospital Corps.

The reputation of the Hospital Corps was
greatly enhanced due to the valor and
performance of duty under fire shown by
individuals serving with the U. S. Marine Corps.
Fifteen Pharmacist Mates were killed in action,
and 146 were wounded or gassed. Two
Pharmacist's Mates received Medals of Honor and
an additional 460 major awards and citations were
given for heroism demonstrated in the conflict.

World War II - Statistics indicate that 97% of
personnel wounded in battle recovered. Hospital
Corpsmen played a major role in preserving the
health of allied prisoners of war. A proud moment
in our rich heritage occurred on February 22,
1945 on the summit of Mount Suribachi, Iwo
J ima, J apan. Along with five Marines, a
Pharmacist Mate, J ohn Bradley proudly
participated in raising the United States flag.

Fifteen Navy enlisted men were awarded the
Medal of Honor during World War II. Seven
awardees were Hospital Corpsman, four of those
for action on Iwo J ima and three for action in
Okinawa.

Korean Conflict - During the Inchon--Seoul
operation in 1950, Hospital Corpsman were on
the forefront of all the fighting. The percentage of
casualties among the corpsmen were greater than
the that of the Marines they supported. Medical
Units attached to the 1st Marine Division cared
for 2844 casualties in 21 days. Hospital
Corpsman were performing life saving treatments
while shell fragments ripped clothing from their
bodies and shattered plasma bottles in their hands,
as described by Secretary J ames Forestall. Highly
trained Hospital Corpsmen played a vital role in
the care and treatment of those evacuated.
Hospital ships handled over 20,000 battle
casualties, 30,000 non-battle casualties and
80,000 outpatients. It is a great tribute to the
Hospital Corps that five out of seven Medal of
Honor recipients were Hospital Corpsmen.

Vietnam - With the massive escalation of the
Vietnam conflict turning to war between 1963
and 1975, Hospital Corpsman were called to
serve in Southeast Asia. They served with such
units as: the U.S. Marine Corps, the Navy
Air/Ground Forces, Naval Support Activity
22
Handbook 1

Hospitals, Hospital Ships, River Warfare, and
Navy ships on the Gun Line off the coast of South
Vietnam. Some Hospital Corpsmen were assigned
as medical advisors to Vietnamese military units
requiring the corpsmen to live in small, poorly
defended villages. They deeply felt the brunt of
the war. Over 600 corpsmen were killed or
mortally wounded in action and another 3353
corpsmen were wounded in action. Awards for
gallantry and intrepidity included four Medals of
Honor.

As political and military uprisings in Beirut,
Grenada and other hotspots around the world
have occurred, Hospital Corpsmen have been
there. Fifteen of the twenty-two Corpsmen
assigned to the Marine Barracks in Beirut,
Lebanon died in the bombing of that barracks.
Corpsmen were also present at sea and on the
shore when the United States took military action
on the island of Grenada in 1980. In the Persian
Gulf, aboard the USS Stark, the Hospital
Corpsmen were awarded the Navy and Marine
Corps Medal for heroic life-saving actions.

Recent conflicts in Somalia, Bosnia-
Herzegorina, Haiti, on the USS Cole, the 9/11/01
disaster, and Operations Desert Shield, Enduring
freedom and Iraqi Freedom have shown that
Hospital Corpsmen continue to serve heroically,
prepared to make the ultimate sacrifice for their
country.

As stated previously, the Hospital Corps is a
very decorated Corps. Twenty-two Hospital
Corpsmen have been awarded the Medal of
Honor, ten posthumously. Corpsmen who served
before, and continue to serve today, have helped
shape our Hospital Corps. The future reputation
of the Hospital Corps will depend upon the
character of the next generation of corpsmen.

Selected Roles

Hospital Corpsmen may be assigned
wherever there is a Naval or Marine Corps
installation. A wide variety of small and large
medical commands exist to serve the health care
needs of the whole Navy population. The
following are types of assignments you will
receive as a Hospital Corpsman.

Naval Hospitals - Offer countless
opportunities for building upon your initial
training as a Hospital Corpsman. You will usually
spend at 18 - 30 months at your first hospital duty
station, working on patient wards, outpatient
clinics, and other areas of the hospital. The Naval
Hospital setting will increase your knowledge of
nursing care, and health care practices. Licensing
requirements for hospitals may limit your
opportunity to perform some procedures.

Clinic Commands - These are not attached
to a Naval Hospital therefore, they have different
guidelines and regulations than those clinics
attached to a Naval Hospital. Usually at this type
of a command a corpsman may be able to expand
his delivery of medical treatment because the
licensure requirements are not as strict. In fact
your role as a corpsman could end up being very
similar to that of a corpsman on a ship.

Surface Ship - This type of duty may be one
of the most challenging. At sea, you will use all
of the knowledge you have received, and gain
more than you can imagine. You will be
responsible for the maintenance of the health and
well being of the crew. You will treat injuries and
wounds, sometimes with the assistance of a
doctor, and sometimes not. Sick call is held every
morning and usually every afternoon by the
Hospital Corpsman. Unfortunately, there is never
a moment's rest on some of the small ships,
because you provide the emergency response
around the clock. Corpsman are great instructors.
They provide in service training for the crew in
basic first aid, CPR, stretcher bearing, etc. The
number of corpsman on a ship varies according to
the size of the ship. Smaller ships have fewer
corpsman. A small ship, for example a cruiser or
frigate, may have one to two general duty
corpsman and one Independent Duty Corpsman
(IDC). On an aircraft carrier you would have an
MSC Officer, two Doctors, a PA, a Nurse, an
IDC, and approximately 30 corpsman of various
specialties to share the work in an emergency
situation.
23
Handbook 1
Fleet Hospitals - These are mobile, land
based advanced care facilities that provide
medical treatment in remote locations. Fleet
Hospitals support major military operations. They
are assembled by the construction battalion
personnel, assisted by an advance party of
Medical Department personnel. The land-based
hospitals are modular-type self-contained units.
You might hear them referred to as Hospital-in-a-
Box.

Fleet Marine Force - The Marine Corps is a
branch of the Navy. Hospital Corpsmen are
responsible for the maintenance of the health and
well-being of Marines as well as treating their
injuries. Prior to assignment with the Fleet
Marine Force, corpsmen will have additional
medical and physical training in the field Medical
Service School located at either Camp Pendleton
CA or Camp Lejuene NC.

Hospital Ships - Large vessels sometimes
built from tanker-like supply ships, are significant
in their size. If all the beds were filled with
patients, the current Hospital Ships (USNS
Comfort and Mercy), would rank as the 9th and
10th largest hospitals in the United States. Size,
however, is not their only asset.
Fleet Hospitals provide most of the health
care services and facilities that are located in
Naval Hospitals. Services or departments in the
fleet hospital include: radiology, laboratory,
operating rooms, post-anesthesia care units
(recovery rooms), and general nursing wards.

Hospital Corpsmen perform duties in all parts
of the hospital. Technicians perform specialized
duties and skills in their respective areas. General
duty corpsmen provide nursing care and perform
general duties required to functionally operate a
hospital. Duty hours are generally 12 hours on
and 12 hours off. Patient census and status dictate
work hours and assignments.

Hospital ships are built to handle combat
casualties requiring: triage, operating rooms,
wards, and various labs including blood bank,
microbiology, and blood chemistry. Hospital
Corpsman make up the majority of the staff pool.
E-3's and below may fulfill duties of other ratings.
As in large Naval Hospitals, the Corpsmen are
trained in advanced nursing care skills involving
both technical knowledge and interpersonal skills.

Seabees are responsible for the perimeter
watch, however, corpsmen may also stand this
watch.

24
Handbook 1 Worksheet

Lesson 1.03

Role of the Hospital Corps Worksheet

1. Hospital Corpsmen perform their duties based on the Navy's Core Values of:

a. Honor

b. Courage

c. Commitment

d. All of the above

2. In 1799, an act of Congress provided a man or boy to serve the surgeon or surgeon's mate. This person
was known as the:

a. Medic.

b. Loblolly Boy.

c. Hospital Corpsman.

d. Pharmacist's Mate.

3. The Surgeon's steward replaced the Loblolly Boy in 1843. A requirement to be a Surgeon's steward was
to be:

a. a licensed pharmacist.

b. over 25 years old.

c. recommended by the ship's surgeon.

d. a master-at-arms.

4. Duties of the Loblolly Boy included:

a.__________________________________

b.__________________________________

c.__________________________________

5. Baymen replaced Male Nurses around 1873

a. True b. False
25
Worksheet Handbook 1

6. Match each description in column B with the rating in column A

A B

a. Apothercary __________

b. Surgeons steward __________

c. Male nurse __________

d. Loblolly boy __________

e. Hospital Corpsman __________

f. Baymen __________

1. 1814 to 1843; first person designated to serve
the surgeon or surgeons mate

2. Position created in 1863 by order of the Navy
Department.

3. Replaced the loblolly boy in 1843, had to have
knowledge of pharmacy.

4. A graduate of a recognized College of
Pharmacy.

5. Replaced male nurses in 1873, received training
prior to seagoing assignment.

6. Established by act of Congress on 17 J une 1898.

7. The first females in the Hospital Corps came in as WAVES in 1944.

a. True b. False

8. Who was the first Hospital Corpsman to receive the Medal of Honor?

a. HMC Pat Powers

b. HR Franklin Roosevelt

c. HA Robert Stanley

d. HN Walt Disney

9. Since 1900, how many Hospital Corpsmen have been awarded the Medal of Honor?

a. 22

b 25

c. 26

d. 28
26

10. A Hospital Corpsman may be assigned wherever there is a Naval or Marine Corps installation.

a. True b. False

11. Hospital Corpsmen assigned to ships are NOT responsible for:

a. medical treatment.

b. maintenance of health and well-being of the crew.

c. education and training of sailors in basic first aid and CPR.

d. training sailors to suture wounds.

12. List four duty stations where Hospital Corpsmen may be assigned.

a. __________________________________________________

b. __________________________________________________

c. __________________________________________________

d. __________________________________________________

13. Prior to assignment with the Fleet Marine Force, a Hospital Corpsman will have further medical and
physical training at the _________ _________ _________ _________.

14. Fleet Hospitals are permanent structures located anywhere the Fleet has ships.

a. True b. False

27
NOTES\COMMENTS

28
Basic Hospital Corps School Lesson 1.04 Introduction to the Bureau
Handbook I of Medicine and Surgery (BUMED)
Lesson 1.04

Introduction to the Bureau of Medicine
and Surgery (BUMED)

Terminal Objective:

1.04 State the Navy Medical Department's basic organizational structure and mission.


1.04.01 List the mission elements and functions of BUMED.

1.04.02 State the purpose and use of the Manual of the Medical Department.

1.04.03 State the duties and responsibilities of selected positions in the Naval Hospital organization.

1.04.04 State the chain of command for a typical entry level Hospital Corpsman in a Naval Hospital

1.04.05 State the duties of Medical Department personnel.

1.04.06 Identify the insignia of Medical Department personnel from examples.

Key Elements and Select Functions of
BUMED

The Chief of the Bureau of Medicine and
Surgery (BUMED) is known as the Surgeon
General of the Navy. The Surgeon General
commands BUMED, and reports directly to the
Chief of Naval Operations. This individual is
responsible for all Navy Medical Department
personnel.

The Mission of the Navy Medical Department
is:

We are the Medical Department of the United
States Navy. Our mission is to ensure the health of
our Sailors and Marines so that they are physically
and mentally ready to carry out their world mission.
We will accomplish this with a comprehensive health
promotion program, and when illness or injury
intervenes, restore optimal health. We will strive
continually to provide this same level of quality
health care to the families of active duty members
and to all others entrusted to our care.

BUMED exists to provide health care and
treatment to sick and injured Navy and Marine
Corps personnel. Medical and dental care and
services are provided as authorized by law or
regulation.

Recipients of health care include: 1) All active
duty personnel of the Navy, the Marine Corps, and
the other uniformed services.

2) Beneficiaries (family members) of all active
duty personnel - Navy, Marine Corps, and other
uniformed services.

3) Retired members of the uniformed services
and their beneficiaries (family members).

4) Eligible survivors of deceased members.

5) Federal civilian employees
29
Lesson 1.04 Introduction to the Bureau Basic Hospital Corps School
of Medicine and Surgery (BUMED) Handbook I

6) Civilian Humanitarian.

Health care is mandated for active duty
members, all others are cared for on a space-
available basis.

BUMED is tasked to provide professional and
technical guidance over performance requirements,
procurement, and utilization of resources. Medical
Department resources are people, facilities,
equipment, and materials. Personnel include
doctors, nurses, dentists, technicians, hospital
corpsmen, etc. Facilities consist of hospitals,
clinics, afloat and operational units, etc.
Equipment ranges from CAT scanner and other X-
ray devices to the beds and tables in a patient
room. Materials are usually disposable, such as
bandages, thermometers, IV tubing, and syringes.

BUMED issues and maintains manuals and
directives, which publish policies and procedures
on medical, dental, professional, technical, and
administrative matters.

Professional and technical guidance and
assistance provided by BUMED establishes
standards on measures for the prevention of illness
and injury to Navy and Marine Corps units.
Measures covered by this guidance include
Environmental Sanitation, Industrial Hygiene
Programs, Preventive Medicine Programs, and
Health Promotion Programs.

The Manual of the Medical Department

One means of providing the professional and
technical guidance required in the fleet is the
Manual of the Medical Department (MANMED).
In the manual, medical department personnel
receive guidance on the quality of care to be given
as well as performance expectations. Duties of all
doctors, nurses, dentists, hospital corpsmen, and
civilians are outlined. Set-up and maintenance of
health records is established. A schedule for
physical examinations is included. Regulations for
pharmacy operation and drug control are provided.
Also, the support requirements for the Feet Marine
Force are given.
Mandatory regulations are established in the
manual that must be adhered to by all Medical
Department commands and personnel. Violations
of BUMED regulations are punishable in
accordance with the Uniform Code of Military
J ustice (UCMJ ).

Commanding Officers receive guidance
regarding their responsibility for the direction and
coordination of all functions in the Naval medical
facility. Medical facilities are run in accordance
with: 1) US regulations, 2) BUMED instructions,
and 3) Other competent authority rules or
regulations.

Duties and Responsibilities of Selected
Positions in the Naval Hospital
Organization

Commanding Officers (CO's) are charged with
efficient and effective operation of the Naval
Hospital. They are responsible for the professional
care and services provided to patients in the
hospital. The safety and well-being of the entire
command sits with the CO.

The Executive Officer (XO) assumes
command in the absence of the Commanding
Officer. Under the CO, the XO is responsible for
the organization, performance of duty, medical
readiness, provision of healthcare services, and
good order of the entire command.

Each Director of Services is responsible for
the coordination and efficient operation of all
matters within their service. They confer with
other directors on matters of mutual concern. They
also plan, direct, coordinate, implement, and
evaluate activities within the directorate.

Select Directorates include:

1) Director for Nursing Services, which covers
inpatient nursing, ambulatory nursing, and
operating room nursing.

2) Director for Medical Services, which covers
internal medicine, dermatology, psychiatry,
pediatrics, preventive medicine, aviation medicine,
and undersea medicine.
30

Handbook I of Medicine and Surgery (BUMED)

3) Director for Surgical services covers
general surgery, orthopedics, obstetrics and
gynecology (OB/GYN), ophthalmology,
anesthesia, urology, and dental.

4) Directorate for Ancillary Services covers
clinical investigations, laboratory, pastoral care,
pharmacy, physical therapy, radiology, social
work, and respiratory therapy.

Chain of Command in a Typical
Hospital

The chain of command follows a logical
sequence. An entry-level corpsman would follow
the chain outlined in figure 1.04.01.

Duties and Insignia of Medical
Department Personnel

Medical Corps Officers (MC) wear a gold oak
leaf with a silver acorn in the center. These doctors
make diagnoses, prescribe and carry out treatment,
evaluate the effectiveness of treatment, and
interpret results of tests and interventions. Patients
and families are given counsel and information
regarding aspects of illness and treatment by
medical officers.

Nurse Corps Officers (NC) wear a gold oak
leaf. Nurses are tasked to implement physician's
orders, develop nursing care plans, provide direct
patient care, assist in evaluation of treatment
through observation, instruct and counsel patients
and families, as well as to instruct, supervise, and
counsel assigned corpsmen.

Dental Corps Officers (DC) wear a gold oak
leaf with two silver acorns at the base. Dentists
make diagnoses of dental health problems,
prescribe and carry out treatment, evaluate the
effectiveness of treatment and interpret results, as
well as counseling patients and families regarding
aspects of illness and treatment.

Medical Service Corps Officers (MSC) wear a
gold oak leaf with a branch at the base. The
Medical Service Corps consists of several allied
health professions including: pharmacists,
optometrists, medical technologists, physical
therapists, dietitians, physician assistants, social
workers, and hospital administrators.

MSC duties are related to their professional
specialty. Pharmacists dispense drugs, physical
therapists direct rehabilitative treatment for
physically incapacitated patients, and optometrists
examine eyes.

Hospital Corpsmen (HM) wear a caduceus.
Corpsmen assist the doctor and/or nurse in
contributing to the effectiveness of patient
treatment and nursing care plans. They provide
direct patient care, identify and report patient
responses to illness or injury and the prescribed
treatment. Corpsmen are assigned to various
medical support areas: admissions, supply, clinics,
and inpatient wards.

Dental Technicians (DT) wear a caduceus with
a D in the center. They assist the dental officer in
the dental care of patients, including clinic,
hospital, and operating room duties. Dental
technicians provide direct patient care.

Summary

The Navy Medical Department is made up of
people, facilities, equipment, and materials.
Guidance is provided by the Surgeon General
using the Manual of the Medical Department. A
typical Navy hospital uses a chain of command
similar to other Navy commands. Medical Corps
officers, Nurse Corps officers, Dental Corps
officers, Medical Service Corps officers, Hospital
Corpsmen, and Dental Technicians all serve in the
Navy Medical Department. Each Corps has its
own unique insignia.
31
of Medicine and Surgery (BUMED) Handbook I
32

FIGURE 1.4.01
Handbook I of Medicine and Surgery Worksheet

Lesson 1.04

Introduction to the Bureau of Medicine and
Surgery Worksheet

1. The mission of the Navy Medical Department is to:

a. fight side by side with the Marine Corps.

b. provide health care to American allies.

c. ensure the health of Sailors and Marines.

d. provide guards for Navy Hospitals.

2. The Manual of the Medical Department gives professional and technical guidance to which of the
following personnel?

a. Doctors (MC)

b. Nurses (NC)

c. Hospital Corpsmen (HM)

d. All of the Above

3. Violations of regulations established in the Manual of the Medical Department are punishable by the:

a. AARP.

b. UCMJ .

c. UCSD.

d. USDA.

4. The person responsible for efficient and effective operation of the Naval Hospital is the:

__________________________.

5. The person responsible under the CO for the organization, performance of duty, medical readiness,
provision of health services, and good order of the entire command is the:

__________________________.

33
of Medicine and Surgery Worksheet Handbook I
6. The person responsible for the coordination and efficient operation of all matters within their service is
the:

__________________________.

7. Match each corps device in column B to the Medical Department personnel who wear it in column A.

A B

a. Medical Officer ______

b. Dental Officer ______

c. Nurse Corps Officer ______

d. Medical Service Corps Officer ______

e. Hospital Corpsman ______

1. Gold Oak Leaf with 2 silver acorns below.

2. Caduceus.

3. Gold Oak Leaf with a branch at the base.

4. Gold Oak Leaf with a silver acorn in the center.

5. Gold Oak Leaf

8. Match the duties in column B to the Medical Department personnel who perform them
in column A.

A B

a. Medical Officer ______

b. Dental Officer ______

c. Nurse Corps Officer ______

d. Medical Service Corps Officer ______

f. Hospital Corpsman ______

1. Develop nursing care plan

2. Identify and report patient responses to illness or
injury and prescribed treatment

3. Duties and responsibilities are specific to their
specialty, e.g., pharmacists dispense drugs

4. Make diagnoses of dental health problems

5. Make medical diagnoses

34
Basic Hospital Corps School Lesson 1.07 Basic Medical Terminology
Handbook 1 and Abbreviations
Lesson 1.07

Basic Medical Terminology and
Abbreviations

Terminal Objective:

1.07 Define medical terms and abbreviations.


1.07.01 Define selected medical prefixes.

1.07.02 Define selected medical suffixes.

1.07.03 Define selected medical abbreviations.

1.07.04 Define selected medical terms.

Basic Elements of a Word

To understand, identify or analyze medical
words, you must understand four elements: word
root, prefix, suffix, and combining form. In
medical terminology, the combination of these
elements brings about the formation of a medical
word.

The root is the main part or foundation of a
word. Examples are the words rower and rowing;
their root word is row. In medical words, the root
most often indicates a body part or part of a body
system. An example is cardiac, pericardial, and
cardiograph. In each case the root, cardi, refers to
the heart. Roots of medical words usually come
from Latin or Greek.

The prefix of a word is a syllable or syllables
placed before the root word to alter, modify, or
change the meaning of the medical word. An
example of a prefix is bradycardia, slow heart
beat. The brady is the prefix.

A suffix is added to the end of a word root to
alter, modify, or actually change the meaning of
the word. An example is cardiology, the study of
the heart. The ology is the suffix.

In combining elements to form medical
words, we often use vowels. Inserting vowels
between the elements, prefix, root, and suffix
makes pronunciation a little easier. An example
is arthroscopy: the root is arthr, a vowel, o, is
inserted, and the suffix, scopy, is added. When
analyzing a medical term, look for the
relationship of the word to a system or part of the
body. The word may be associated with bodily
functions in both health and in disease. For
example, arthroscopy is the visual examination of
a bone joint of the body. This medical term will
mean more to you as you learn the
musculoskeletal system in detail, how the system
functions, and various states of health and illness
of the musculoskeletal system.

Finally, as you build upon your ability to
build medical words, analyze and form
relationships between words, systems and
functions of the body, you will need to constantly
be aware of the spelling of medical words.
Incorrect spelling in your documentation of
35
Lesson 1.07 Basic Medical Terminology Basic Hospital Corps School
and Abbreviations Handbook 1
patient care can mislead a reader giving them
incorrect or false information.

In order to learn medical terminology, you
need to thoroughly familiarize yourself with
medical prefixes, suffixes, and abbreviations.

Selected Medical Prefixes

A. a, an -- without, not, lack of, absence of.
B. anti, ant -- against, counter.
C. arthr -- joint
D. brady -- slow.
E. cardi -- heart.
F. cerebr -- cerebrum.
G. chol -- bile.
H. cyst -- bladder.
I. colo -- colon.
J . derm -- skin.
K. dys -- difficult, painful.
L. enter -- intestine.
M. gastr, gastro -- stomach.
N. genito -- organs of reproduction.
O. gyno, gyn -- woman, female.
P. hem, hemo -- blood.
Q. hepat, hepato -- liver.
R. hyper -- above, beyond, under.
S. hypo, hyp -- below, under.
T. ili, ilio -- lower abdomen, intestine.
U. lapr, lapro -- flank, abdominal.
V. laryng -- relating to the larynx.
W. lith, litho -- stone.
X mal -- bad, abnormal.
Y. micr, micro -- small.
Z. nas, naso nasal
AA. nephr, nephro -- kidney.
AB neur, neuro -- nerve.
AC. olig, oligo -- few, small.
AD. opthalm -- eye.
AE. or, oro -- mouth.
AF. ost, oste -- bone.
AG. ot, oto -- ear.
AH. pharyng -- throat.
AI. phleb -- vein.
AJ . pneum, pneumo -- relating to lung, breath,
air.
AK. proct, procto -- anus.
AL. pulmo -- lung.
AM. tachy -- rapid, swift.
AN. thorac -- chest, thorax.
AO. thromb -- clot, lump.
AP. trache, tracheo -- trachea, windpipe.
AQ. ur, uro -- urine.
AR. vas, vaso -- vessels.

Selected Medical Suffixes

A. ectomy -- surgical removal of an organ or
part.
B. esthesia -- perceive, feel (sensation).
C. graph, gram -- scratch, write, record.
D. iasis -- a condition, process.
E. itis -- inflammation, swelling.
F. meter -- measure.
G. ology -- the study of.
H. oma -- tumor.
I. osis -- disease, condition, abnormal increase.
J . ostomy, stomy -- artificial opening.
K. plegia -- paralysis, stroke.
L. pne, pnea -- breathing.
M. scope to look at, an instrument for
examining or observing.
N. uria -- urine.

Selected Medical Abbreviations

A. A -- before, admission.
B. a.c. -- before meals.
C. ad lib -- as much as desired; at pleasure.
D. BE -- barium enema.
E. b.i.d.-- twice a day.
F. B.P. -- blood pressure.
G. BRP -- bathroom privileges.
H. c -- with.
I. C & S -- culture and sensitivity.
J . cap -- capsule.
K. CBC -- complete blood count.
L. CXR chest x-ray
M. D -- discharged.
N. DC -- discontinue.
O DOS -- day of surgery.
P. ECG, EKG -- electrocardiogram.
Q. EEG --electroencephalogram.
R. exam -- examination.
S. Fr French
T. H20 -- water.
U. h, hr -- hour.
V. h.s. -- at bedtime, hour of sleep.
W. I & O -- intake and output.
X. I.M. -- intramuscular.
Y. I.V. -- intravenous.
Z lab -- laboratory.
AA. MOOD, MOD -- Medical Officer of the
Day.

36
Handbook 1 and Abbreviations

AA. NOOD, NOD -- Nurse of the Day.
AB n.p.o. -- nothing by mouth.
AC. NSS or NS -- normal saline solution.
AD. O2 -- oxygen.
AE. OR -- operating room.
AF. p -- after.
AG. p.c. -- after meals.
AH. p.o. -- by mouth, orally.
AI. post--op -- postoperative.
AJ . pre--op -- preoperative.
AK. p.r.n., PRN -- as needed.
AL. q -- every.
AM. q.d. -- every day.
AN. q4h -- every 4 hours.
AO. q.i.d. -- four times a day.
AP. q.o.d. -- every other day.
AQ. R & M. -- routine and microscopic.
AR. s -- without.
AS. ss -- one half.
AT. s.c., S.Q. -- subcutaneous.
AU. SL -- serious list, sublingual.
AV. spec. -- specimen.
AW. sp. gr. -- specific gravity.
AX. stat -- immediately.
AY. surg -- surgery.
AZ. tab -- tablet.
BA. t. i. d. -- three times a day.
BB. T. P. R. -- temperature, pulse, respiration.
BC. U. A. -- urinalysis.
BD. UGI -- upper gastrointestinal.
BE. VDRL -- venereal disease research
laboratory.
BF. VS -- vital signs.
BG. VSL -- very serious list.
BH. R -- Right.
BI. L -- Left.

Define selected medical terminology.

A. Acute --sudden onset sharp, short sever in
course.
B. Ambulatory -- Walking or able to walk.
C. Anorexia -- Loss of appetite.
D. Apnea -- Absence of breathing.
E. Bradycardia -- Slow heartbeat.
F. Cardiology -- Study of the heart and its
function.
G. Chronic -- Long and drawn out.
H. Colostomy -- Artificial opening of the colon.
I. Communicable -- Infectious or contagious,
capable of transmitting disease.
J . Dermatology -- Medical specialty concerned
with the diagnosis and treatment of disease of
the skin.
K. Diagnosis -- Identifying a disease or injury
from its signs and symptoms.
L. Disease -- Any deviation from or interruption
of the normal structure or function of any
parts, organ or system (or combination
thereof) of the body. Manifested by a
characteristic set of symptoms and signs and
whose etiology, pathology, and prognosis
may be known or unknown.
M. Diaphoresis -- Profuse sweating.
N. Dysuria -- Painful urination.
O. Gastrectomy -- Surgical removal of part of
the stomach.
P. Geriatric -- Term used to describe the older
patient.
Q. Gurney -- A wheeled cot used in hospitals.
R. Gynecology -- branch of medicine which
treats diseases of the genital tract in women.
S. Health -- state of optimal physical, mental,
and social, and spiritual well--being, Not
merely the absence of diseases and infirmity.
T. Hematology -- branch of medical science that
studies the morphology of the blood and
blood-forming tissues.
U. Hepatitis -- inflammation of the liver.
V. Hypodermic -- under the skin.
W. Medicine -- art and science of the diagnosis
and treatment of disease and the maintenance
of health.
X. Nephrology -- study (science) of the kidney's.
Y. Neurological -- relating to the branch of
science that has to do with the nervous system
and its disorders.
Z. Obstetrical -- relating to all phases of child
birth.

AA. Ophthalmology -- branch of medicine
dealing
with the eye, its anatomy, physiology, and
manifestations of disease.
AB. Orthopedics --branch of medicine which is
specially concerned with the preservation
and restoration of the skeletal system, its
articulations, and associated structures.
AC. Ophthalmoscope -- Instrument to examine
the eye.
AD. Otoscope -- instrument to examine the ear.

37
AK. Psychiatry -- branch of medicine that deals
with the study, treatment, and prevention of
mental illness.
AE. Pathology -- the structural and functional
manifestations of diseases.
AF. Pediatrics -- medical practice devoted to
care of children. AL. Radiology -- branch of health science that
deals with the use of radiant energy in the
diagnosis and treatment of disease.
AG. Plastic surgery -- branch of medicine
concerned with building and restoring
tissue. AM. Surgery -- branch of medicine which treats
diseases, injuries, and deformities by
manual or operative methods.
AH. Pleura -- layer of smooth, glistening tissue
that covers the lungs.
AN. Tachycardia -- fast heartbeat. AI. Proctology -- branch of medicine
concerned with disorders of the rectum and
anus.
AO. Thoracic -- pertaining to or affecting the
chest.
AP. Thrombophlebitis -- inflammation of, and
clot formation in a vein.
AJ . Prognosis -- forecast as to the probable
outcome of an attack or disease. The
prospect as to recovery from a disease as
indicated by the nature and symptoms of
the case.
AQ. Urology -- branch of medicine that is
concerned with the urinary tract in both
males and females, and with the genital
organs in male.

38
Handbook 1 and abbreviations
SCENARIO FOR MEDICAL TERMS AND
ABBREVIATIONS

1. Mrs. Daisy was A to a general surg ward for a pre-op for both a colostomy and gastrectomy.

2. Her work up included: ECG, PE, VDRL, CBC, CXR, UA C&S.

3. She ambulated to the Cardiology clinic for her ECG.

4.. The lab obtained a UA and ran a sp gr on it. Her CBC was sent to Hematology for analysis. Next she
went to Radiology for CXR. Lastly she was seen in the Surgery clinic for her UGI.

5. Her M.O. told her on exam that she has Chronic Dysuria. He sent her to the Urology clinic for a consult,
then to Nephrology for a second opinion.

6. p the Scope they placed her NPO, started an IV and placed her on VSL.

7. The M.O. order ss tab TID PO to be given post-op.

8. After the O.R. the NOOD placed a 12 FR foley catheter for a UA C&S. The patient no longer has BRP
and is placed on I/O Q4hrs.

9. The M.O. also wants a q.d. weight and q.o.d. lab tests as a standing post-op order.

10. Mrs. Daisy has Tylenol ii caps po qid and Demerol 50mg IM PRN q 4-6Hrs. ordered for pain control.

11. Her BP went up and she was given a tab SL STAT s relief. Her R calf was swollen and the MOOD
diagnosed it as thrombophlebitis.

12. Mrs. Daisy was then taken via a Gurney to the Medicine clinic due to acute pain in her R calf. Since it
was her DOS the corpsman placed 2L O2 per NC and gave her ss cc S.Q. of Heparin as per order.

13. The doctor examined her: Ophthalmic, Oro, Osteo, Oto, Pharyngeal, Pulmo, and Procto.

14. The doctor found an bradycardia, hepatitis, and gastritis during his exam.

15. The M.O. ordered NSS IV to be DC'd at 2145.

16. Her prognosis is good.
39
NOTES/COMMENTS

40
Handbook 1 and Abbreviations Worksheet

Lesson 1.07

Basic Medical Terminology and
Abbreviations Worksheet

1. Match each definition in column B to the correct medical prefix in column A.

A B

a. tacky __________

b. hem/hemo __________

c. nephr/nephro __________

d. or/oro __________

e. ot/oto __________

f. thromb __________

g. brady __________

h. phelb __________

i. a/an __________

j. pneum/pneumo __________

k. dys __________

l. olig/oligo __________

m. lith/litho __________

n. ur/uro __________

1. clot, lump

2. few, small

3. urine

4. mouth

5. difficult, painful

6. without, not, lack of, absence of

7. slow

8. kidney

9. ear

10. stone

11. blood

12. rapid, swift

13. relating to lung, breath, air

14. vein

41
Lesson 1.07 Basic Medical Terminology and Basic Hospital Corps School
Abbreviations Worksheet Handbook 1
2. Match each medical suffix in column B to the correct condition in column A.

A B

a. inflammation __________

b. paralysis __________

c. surgical removal of an organ or part __________

d. blood __________

e. sensation __________

f. urine __________

g. breathing __________

h. artificial opening __________

1. urea

2. ostomy/stomy

3. itis

4. plegia

5. pne/pnea

6. esthesia

7. ectomy

8. emia

3. List the medical abbreviation for each term.

a. Twice a day _______________

b. Three times a day _______________

c. Four times a day _______________

d. Every day _______________

e. Every other day _______________

f. Sublingual _______________

g. Nothing by mouth _______________

h. Before _______________

i. After _______________

j. With _______________

k. As much as desired _______________

l. Without _______________

m. Oxygen _______________

42
Handbook 1 and Abbreviations Worksheet

n. Water _______________

o. Discontinue _______________

p. As needed _______________

q. Vital signs _______________

r. One half _______________

s. Immediately _______________

4. Fill in the blanks with the term being defined.

a. Identifying a disease or injury from its signs and symptoms.
______________________________________________________

b. A forecast as to the probable outcome to an attack or disease.
______________________________________________________

c. Pertaining to or affecting the chest.
______________________________________________________

d. Long and drawn out.
______________________________________________________

e. A wheeled cot used in hospitals.
______________________________________________________

f. A layer of smooth, glistening tissue that covers the lungs.
______________________________________________________

g. Relating to the branch of science that has to do with the nervous system.
______________________________________________________

h. Branch of medicine concerning the urinary tract.
______________________________________________________

i. Slow heartbeat.
______________________________________________________

j. Absence of breathing.
______________________________________________________

k. Painful urination.
______________________________________________________

l. Removal of part of the stomach
______________________________________________________

43
Lesson 1.07 Basic Medical Terminology and Basic Hospital Corps School
Abbreviations Worksheet Handbook 1
m. Inflammation of the liver.
______________________________________________________

n. Under the skin.
______________________________________________________

NOTES/COMMENTS

44
Basic Hospital Corps School Lesson 1.08 Anatomy and Physiology:
Handbook 1 Total Man
Lesson 1.08

Anatomy and Physiology:
Total Man

Terminal Objective:

1.08 List the major organs and systems of the human body.


1.08.01 List the characteristics of Reference Man

1.08.02 Define anatomical directional terms.

1.08.03 List the four body planes.

1.08.04 State the four basic structural levels.

1.08.05 List the cavities of the body and major organs they contain.

1.08.06 State the basic functions and location of major body systems.

Anatomical Position

Medical professionals communicate and
explain exactly where a certain part or aspect of
the body is located by using a universal language.
Directional anatomical terms are used so everyone
explains or communicates in the same way. When
you describe parts of the body, begin by looking at
the body as it faces you; head facing forward,
palms of the hands open and facing you, and feet
pointed forward. This position of the body is
commonly known as the reference man.
Characteristics of the reference man are: age -22
year old male, weight - 70 kilograms/154 pounds,
height - 5', ll"/71 inches.

Directional Terms

Anterior and ventral are terms that refer to
the front or forward position of the body.

Posterior or dorsal are terms that refer to the back
of the body.

Medial refers to the center, or midline, of the
body. Lateral, on the other hand, refers to away
from the center, or midline, of the body, figure
1.08.01.

Proximal and Distal are terms used to
describe the distance from a given reference point.
Points closer to the reference point are said to be
proximal. Distal is further away from the reference
point. Finally, superior refers to higher or above
another point or structure in the body, while
inferior refers to lower, or below another point or
structure in the body.

Four Planes of the Body

45

Lesson 1.08 Anatomy and Physiology: Basic Hospital Corps School
Total Man Handbook 1

In geometry, a student learns about planes
passing through space. In anatomy, the body and
its parts or aspects can be discussed with respect to
planes passing through it, figure 1.08.02.

The median (midsagittal) plane passes
vertically through the body from head to toe,
dividing it into equal right and left sides. A
sagittal plane describes a line passing vertically
through the body dividing it into unequal left and
right sides, but still lying parallel to the median
plane.

Transverse is the term that refers to a plane
passing horizontally through the body, dividing it
into upper and lower portions at a certain point or
aspect.

The frontal plane divides the body into
anterior or posterior portions by making a right-
angle turn from the median or sagittal plane. In
other words this frontal plane divides the body into
front or back portions.

Basic Structural Levels

The human body is organized into four
structural levels: cells, tissue, organs, and
systems.

Cells comprise the simplest structural level.
The cell is the basic structural and functional unit
of the human body. A cell is composed of a
nucleus that controls its function with other organs
and is surrounded by a membrane within a fluid-
like atmosphere. Cells have different structures
and perform many different functions. There are
many types of cells, including: nerve cells; muscle
cells, and blood cells.

Tissues are groups of similar cells joining
together to perform a function. Groups of cells and
the material between (tissue) usually have a
similar origin, and formed together perform
specialized functions. Some examples of tissue
are: epithelium, muscle, connective, and nervous
tissue.

Organs are an organized group of similar
tissues. This level of organization is higher than
the cellular or tissue levels. Organs are structures
that have specific functions and they might have
recognizable shapes. Examples of organs are the
heart, lungs, brain liver, and stomach.

A system is one or more organs working
together to perform a body function. Organs in a
system are associated with a common function.
Examples of systems are: the digestive system, the
pulmonary system, and the cardiovascular system.

Cavities of the Body and Major Organs

Body cavities contain internal organs and may
be separated by structures such as muscles or
bones. The body has two large cavities that are
separated by the frontal plane.

The major cavity in the back or posterior
portion of the body is the dorsal cavity. It contains
the cranial cavity, and the spinal canal.

The cranial cavity is formed by the bones of
the skull and houses the brain. The spinal canal
contains the spinal cord and the beginnings of the
spinal nerves.

The thoracic cavity is in the upper division
between the neck and the respiratory diaphragm.
This cavity houses the heart and lungs. The lower
division houses the abdominnopelvic cavities.

The abdominal cavity lies between the
respiratory diaphragm and the pelvis. This cavity
contains the liver, spleen, pancreas, small and
large intestines, the stomach, and the appendix.

The pelvic cavity which is the lower cavity of
the abdominopelvic division contains the urinary
bladder, sigmoid colon, rectum, and female
reproductive organs (uterus, and ovaries).

The spinal cavity is formed by the bones of
the spinal column which contains and protects the
spinal cord.

46
Functions and Location of Body
Systems

Integumentary System

The skin and its accessory structures, such as
hair, nails, and glands make up the integumentary
system. The skin is considered an organ
responsible for several functions. As the outer
covering of the body, it protects underlying
structures and performs functions essential to life,
including: regulating body temperature through
sweating and insulation; receiving stimuli such as
pain, temperature, touch, and pressure through
nerve endings; and assisting in the excretion of
small amounts of water, salts, and other
compounds. In addition, the production of vitamin
D, which helps us absorb calcium and
phosphorous from the food we eat, begins in the
skin.

Musculoskeletal System

The musculoskeletal system is made up of
the bones of the skeleton and the muscles of the
body. Together they perform many functions vital
to our existence.

The skeletal system performs such functions
as: support of the body, protection of internal
organs, movement of the body with the help of
muscles, and storage of minerals, blood cell
producing cells, and energy.

The muscular system helps the skeletal
system provide movement by causing contraction
and relaxation of all muscles. Comprising 40% to
50% of the total body weight, muscle tissue helps
the body maintain posture. By contracting certain
muscles, the body holds its position or posture
when standing and sitting. The third function of
muscle tissue is assisting in the production of heat.
Muscle contractions cause most of the heat that
keeps us warm and maintains body temperature.

Cardiovascular System

The cardiovascular system is a closed-loop
system comprised of blood, the heart, and the
blood vessels. Blood is a complex liquid that
services all of the body's tissues. It transports
oxygen from the lungs to the cells of the body,
carbon dioxide from the cells to the lungs,
nutrients from the gastrointestinal tract, waste
products and heat from the cells, and protects
against blood loss and infection.

The heart, a hollow, muscular organ, is the
center of the cardiovascular system. It
continuously pumps over 1800 gallons of blood
each day through over 60,000 miles of blood
vessels throughout the body. The heart is located
in the thoracic cavity situated between the lungs.

Respiratory System

With the help of the cardiovascular system,
the respiratory system supplies oxygen to the
cells of the body, and eliminates carbon dioxide
from the cells of the body. The respiratory system
consists of the: nose, pharynx, larynx, trachea,
bronchi, and the lungs.

Lymphatic System

The lymphatic system is a system of vessels
which collect, filter, and return interstitial fluid to
the blood. It consists of tissue, nodes, and vessels
found throughout the body. Lymphatic tissue also
functions in surveillance and defense, destroying
bacteria that enter the body. The lymphatic system
also participates in the manufacture of white blood
cells.

Digestive System

The digestive system is made up of the
gastrointestinal tract (or alimentary canal) and
accessory structures. Organs which make up the
gastrointestinal tract include the mouth, pharynx,
esophagus, stomach, small intestine, and large
intestine. Digestive system accessory structures
47
include the teeth, tongue, salivary glands, liver,
gallbladder, and pancreas.

The functions of this system are: 1) to
transport and prepare food for absorption and use
by the body, and 2) to excrete wastes. Preparing
food for consumption takes place in four digestive
processes. Ingestion refers to taking food into the
body. Movement of food through the system is
the second step in the preparation. Digestion takes
place specifically when food is broken down by
both chemical and mechanical processes. Finally,
digested food is absorbed from the gastrointestinal
tract into the cardiovascular and lymphatic
systems for transport to the cells of the body.
Defecation is the elimination of indigestible
substances from the gastrointestinal tract.

Nervous System

The nervous system consists of nervous
tissue, spinal cord, spinal nerves, the brain, and
cranial nerves. The nervous system is divided into
sensory, motor and integrative systems, and the
autonomic nervous system. The function of the
nervous system is to receive and interpret internal
and environmental information. Because of the
nervous system, the body is able to control and
coordinate all body activities, and adjust the body
to changes in the environment.

Endocrine System

The endocrine system is a system of glands
which secrete hormones that aid in the control,
development, and integration of bodily functions.
It affects bodily activities by releasing chemical
messengers (hormones) into the vascular system or
bloodstream. The system as a whole sends
messages to cells in virtually any part of the body,
bringing about changes in the rate of bodily
activities.

Urinary System

The urinary system is comprised of two
kidneys, two ureters, one urinary bladder, and a
single urethra. Its primary function is to help keep
the body in physiologic balance by controlling the
composition and volume of blood. The urinary
system filters blood and excretes waste products.
The organs of the urinary system are located in the
abdominopelvic cavity.

Reproductive System

Reproduction is the mechanism whereby the
thread of life continues. It is both the process of
cell duplication and the passing of human
characteristics to the next generation. Grouped by
function, the organs of reproduction are gonads
(testes, ovaries), ducts, and accessory sex glands.

48

FIGURE 1.08.01
49
FIGURE 1.08.02
50
Handbook I Total Man Worksheet
Lesson 1.08

Total Man Worksheet

1. Reference Man weighs how much?

a. 60 kg

b. 70 kg

c. 80 kg

d. 90 kg

2. Reference Man is how tall?

a. 5' 5"

b. 5'11"

c. 6'

d. 6' 3"

3 Reference Man is standing erect with palms facing forward.

a. True b. False

4. Match each definition to the correct term.

a. Anterior_______ 1. Lower than or below another structure

b. Lateral________ 2. Higher than or above another structure

c. Distal_________ 3. Toward the back

d. Inferior________ 4. Toward the front, or forward

e. Posterior_______ 5. Closer to a reference point

f. Proximal_______ 6. Farther from a reference point

g. Superior_______ 7. Away from the midline

51

Total Man Worksheet Handbook 1
5. The median plane divides the body into:

a. right and left halves.

b. upper and lower portions.

c. anterior and posterior pos

d. unequal right and left portions.

6. The frontal plane divides the body into:

a. right and left halves.

b. upper and lower portions.

c. anterior and posterior portions.

d. unequal right and left portions.

7. One or more organs working together to perform a bodily function is known as a :

a. tissue.

b. cell.

c. system.

d. tract.

8. What is the simplest of the basic structural levels?

a. Tissues

b. Organs

c. Systems

d. Cells

9. Which system protects underlying tissues against injury and infection and regulates body
temperature.

a. Cardiovascular

b. Musculoskeletal

c. Integumentary

d. Lymphatic

52

Handbook 1 Total Man Worksheet
10. Which system receives and interprets internal and environmental information?

a. Nervous

b. Lymphatic

c. Digestive

d. Endocrine

11. The testes, penis, ovaries, and vagina are parts of the _________ system?

a. endocrine

b. lymphatic

c. musculoskeletal

d. reproductive

12. Which system provides movement and protects vital organs?

a. Endocrine

b. Musculoskeletal

c. Reproductive

d. Nervous

13. Blood is transported throughout the body by the __________ system.

a. nervous

b. cardiovascular

c. digestive

d. integumentary

53

Total Man Worksheet Handbook 1
NOTES/COMMENTS
54

Handbook 1 The Cardiovascular System
Lesson 1.13

The Cardiovascular System

Terminal Objective:

1.13 List the structures of the cardiovascular system and explain their basic functions.


1.13.01 List the location, anatomic structures, and functions of the heart.

1.13.02 List and identify the components of the cardiac conduction system and their functions.

1.13.03 List the type of blood vessels and their functions.

1.13.04 Trace the flow of blood through the heart, to the head and neck region, and through the upper and
lower extremities.

1.13.05 List the elements of blood and their functions.

THE HEART

The heart is the center of the cardiovascular
system. Cardio refers to the heart; vascular refers
to blood vessels (or an abundant blood supply).
The heart is a hollow, muscular organ,
approximately the size of a closed fist. It lies just
above the diaphragm, near the middle of the
thoracic cage between the lungs. About 2/3 of the
heart lies to the left of the midline, between the
second and sixth ribs. It is posterior to the sternum
and anterior to the spine. The heart is contained
within a triple-layered bag, called the pericardium,
that surrounds and protects it. Pericardial fluid is
the serous fluid between the layers of the
pericardium that acts as a shock absorber.

There are three layers of the heart wall, Figure
1.13.01. The epicardium, is a thin, transparent
outer layer, which is made of connective tissue.
The myocardium, or the middle layer, is made of
cardiac muscle fibers. This is the thickest layer of
the heart muscle. Cardiac muscle fibers are
involuntary, meaning they do not require
conscious control to function. The endocardium
is the smooth, inner lining of the heart.

The heart is actually a double-sided pump
divided into right and left sides. There are two
chambers on each side, or four in all.

The heart is divided into four chambers which
receive blood during circulation. The two upper
chambers are called atria, the two lower chambers
are the ventricles. A septum separates the heart
into right and left sides. Between each chamber are
valves which prevent backflow of blood. The tip of
the left ventricle forms the apex, or the pointed end
of the heart.

The right atrium receives deoxygenated
venous blood from the body via the superior and
inferior vena cava, Figure 1.13.02. The coronary
sinus collects venous blood from the heart itself
and also empties into the right atrium.

Blood flows from the right atrium into the
right ventricle. The tricuspid valve prevents
55
The Cardiovascular System Handbook 1
backflow of blood from the right ventricle into the
right atrium.

From the right ventricle, deoxygenated blood
is pumped into the lungs via the pulmonary
artery. This is the ONLY artery in the body that
carries deoxygenated blood. The pulmonary
semilunar valve lies at the entrance of the
pulmonary artery to prevent backflow of blood
from the artery back into the right ventricle. Soon
after the pulmonary artery leaves the right
ventricle, it bifurcates, or splits, into a right and
left vessel, one going to each of the lungs.

In the lungs, blood is oxygenated. Red blood
cells exchange CO2 for oxygen. Oxygenated blood
flows back to the left side of the heart via the
pulmonary veins. These are the ONLY veins in
the body that carry oxygenated blood.

The pulmonary veins carry blood to the left
atrium. From the left atrium blood is pumped into
the left ventricle. The valve between the left atrium
and ventricle is the mitral or bicuspid valve. The
left ventrical is the largest and most muscular
chamber of the heart. The ventricular wall is
thicker because it pumps blood to the entire body.

From the left ventricle, blood travels through
the aorta out to the rest of the body. The aortic
semilunar valve lies at the entrance of the aorta,
and prevents backflow of blood into the left
ventricle.

Coronary arteries and veins carry blood for
nourishment, 02, and exchange metabolic wastes
for the heart muscle itself, Figure 1.13.03

THE CONDUCTION SYSTEM OF
THE HEART

The conduction system is the network of
specialized cardiac muscle fibers that transmit
electric impulses that cause the heart to contract
(beat). These specialized fibers are autorhythmic
(self-excitable), which means they are able to
repeatedly and rhythmically generate impulses by
themselves. The purpose of the conduction system
is to ensure that the cardiac chambers contract in a
coordinated manner which makes it an effective
pump.

The conduction system is influenced by the
autonomic nervous system. It sends signals that
modify the heartbeat but it does NOT establish the
fundamental rhythm. Hormones such as
epinephrine increase the heartbeat. Calcium (an
ion) in the blood increases the strength of
contraction.

The conduction system consists of the
sinoatrial (SA) node, the atrioventricular (AV)
node, the bundle of His, bundle branches, and the
Purkinje fibers, Figure 1.13.04.

The sinoatrial, or SA node, is known as the
pacemaker of the heart. It is located in the right
atrium. The wave of electrical activity starts here
and spreads to the atrioventricular node. The AV
node is located just above the right ventricle and
regulates the ventricles. The electrical impulse is
delayed here to allows the atria time to complete
their contraction and to add to the volume of blood
before ventricular contraction begins. The AV
node controls the pacing of the ventricles. From
the AV node, the impulse is conducted to the
bundle of His, the right and left bundle branches,
and finally the Purkinje fibers. The Purkinje
fibers pass the electrical impulse to the cells of the
myocardium, causing them to contract.

THE BLOOD VESSELS

Blood vessels provide for passage of blood
through the cardiovascular system. They are made
up of smooth, involuntary muscles which means
they work without conscious control. There are
five types of blood vessels: arteries, arterioles,
capillaries, venules, and veins.

Arteries are thick--walled vessels that
transport oxygen-rich blood away from the heart to
the body. The ONE exception is the pulmonary
artery which transports deoxygenated blood away
from the heart to the lungs. The aorta is largest
artery, and largest blood vessel in the body, Figure
1.13.05. It rises from the left ventricle and has four
principle divisions. The ascending aorta branches
off to the right and left coronary arteries which
supply blood to the heart. The arch of the aorta
56
supplies blood to the right and left sides of the
head, neck, and upper extremities. The thoracic
aorta supplies blood to the chest cavity and lungs.
The abdominal aorta supplies blood to the entire
abdominal cavity and pelvic region. Some arteries
are known as landmarks, Table 1.13.01 and Figure
1.13.06.

Arterioles are very small, almost microscopic
arteries. They transport blood to the capillaries.
They also play a key role in regulating the blood
pressure. Capillaries are microscopic blood
vessels that connect arterioles and venules. Their
primary function is to exchange nutrients, gases,
and metabolic wastes between blood and tissue
cells.

Venules collect blood from the capillaries and
tissues and drain into veins. The largest portion of
blood volume at rest, about 60%, is in venules and
veins. Veins are thinner-walled vessels that return
blood. They contain one-way valves which prevent
the backflow of blood.

Veins carry deoxygenated blood from the
periphery back to the heart. The ONE exception is
the pulmonary veins which carry oxygenated
blood from the lungs to the heart.

The body has three mechanisms which
contribute to returning blood to the heart.

1. The heart itself pumps the blood to circulate
through the body. Pressure is lowest in the
veins.

2. When skeletal muscles contract, they tighten
around the vein running through them. This
causes an increase in venous pressure to the
heart and opens a proximal valve. When
muscles relax, the valve closes. This is known
as the skeletal muscle pump.

3. The respiratory system causes changes in
pressure in the thoracic and abdominal
cavities. During inspiration, the diaphragm
moves downward. As a result, abdominal
veins are compressed and blood is forced into
thoracic veins.

Veins are classified by their anatomical
association with major bones and depth in the
body, i.e., superficial or deep. The most significant
veins are the superior vena cava and inferior vena
cava. These veins receive blood from the body and
empty it back into the right atrium.
FLOW OF BLOOD THROUGH
THE BODY

Blood enters the right atrium from the
coronary sinus and from the superior vena cava
and inferior vena cava. It is pumped into the right
ventricle via the tricuspid valve.

Blood is then transported to the lungs through
the pulmonary artery; the pulmonary semilunar
valve prevents backflow. It returns to the left
atrium through the pulmonary veins.

Blood then enters the left ventricle; backflow
is prevented by the mitral valve. The left ventricle
pumps blood to the body through the aorta.
Backflow is prevented by the aortic semilunar
valves.

Blood flow to the body begins to divide at the
aorta.

BLOOD SUPPLY TO THE HEAD AND
NECK REGION

Blood flows through the arch of the aorta to
the right and left common carotid arteries, Figure
1.13.07. Blood returns via the internal and external
jugular veins to the subclavian veins.

BLOOD SUPPLY TO THE UPPER
EXTREMITIES

Blood flows to the arch of the aorta to the left
and right subclavian arteries. Axillary arteries
transport blood to the brachial arteries, Figure
1.13.08. Brachial arteries divide into the radial and
ulnar arteries. Arteries of the hand further divide,
ending with the digitalis arteries.

Blood is returned via the radial, ulnar,
cephalic, and median cubital veins from the hand
and forearms. Brachial veins transport blood from
the antecubital area through the upper arm.
57
Axillary veins carry blood from the upper arm into
the thorax veins. At the level of the first rib they
become the subclavian veins.

Subclavian veins receive blood from the axillary
and internal jugular veins. They unite with internal
jugular veins to form brachiocephalic veins. The
right and left brachiocephalic veins unite to form
superior vena cava.

BLOOD SUPPLY TO THE LOWER
EXTREMITIES

Blood enters the abdominal aorta and branches
to the common iliacs. Femoral arteries, Figure
1.13.09, receive blood from the external iliac
branch of the common iliacs and deliver blood
through the popliteal to the posterior tibial and the
dorsalis pedis arteries.

Blood is returned via the posterior and anterior
tibial veins, the popliteal vein to the femoral vein.

Superficially, the great and small saphenous
veins receive blood from the foot as well as the
medial and posterior portions of the lower legs.
The great saphenous vein is the longest vein in the
body. The left and right external iliacs transport
the blood via the inferior vena cava.

Blood is arrives at the heart through the
inferior vena cava and superior vena cava.

THE BLOOD

Blood is a liquid connective tissue that has
three general functions:

1. Transportation of:

a. Oxygen from the lungs to the cells of the
Body and carbon dioxide from the cells to
the lungs

b. nutrients from the gastrointestinal tract to
the cells, heat and waste products away
from the cells

c. hormones from endocrine glands to other
body cells

2. Regulation of:

a. pH through buffers

b. body temperature through the heat
absorbing and coolant properties of its
water content and its rate of flow through
the skin

d. osmotic pressure influences the water
content of cells through dissolved ions
and proteins

3. Protection of the body through:

a. clotting mechanism protects against blood
loss

b. antibodies, interferon and complement
system protect
against foreign microbes and toxins

Total blood volume of the average adult is
5.25 liters. This volume remains constant because
blood cells are continually replaced as they
become worn, damaged, or are lost.

The fluid known as blood is actually
composed of many parts. The liquid portion of the
blood is plasma. Suspended in plasma are the
formed elements of the blood: red blood cells
(erythrocytes), white blood cells (leukocytes), and
platelets (thrombocytes).

Plasma, the straw-colored liquid portion of the
blood, is made up of 91.5% water. The other 8.5%
contains the proteins that maintain the viscosity
(thickness) of blood and antibodies that are
essential to the body's ability to protect itself
against illness. Plasma carries the formed
elements, nutrients, wastes, regulatory substances,
gases, and electrolytes through the circulatory
system to the body's tissues.

Red blood cells (RBCs), also called
erythrocytes, are small, disc-shaped cells whose
primary job is to transport oxygen to, and carbon
dioxide away from, the body's cells. Oxygen and
carbon dioxide molecules are carried by an
element of the RBC (red blood cell) known as
58
White blood cells, also called leukocytes, are
the body's primary defense against infection. They
help protect the body from pathogenic organisms
by ingesting or breaking down the bacteria (a
process called phagocytosis).
hemoglobin (Hgb). The hemoglobin molecule
gives blood its characteristic red color. The red
will vary, depending upon the combination of
hemoglobin and oxygen; well oxygenated
hemoglobin produces a bright red color, whereas
deoxygenated hemoglobin produces a dark red
color. Red blood cells are manufactured in the
marrow of the long bones.

Platelets, also called thrombocytes, play a
vital role in the clotting (coagulation) of blood
when tissue is damaged or hemorrhage occurs.

FIGURE 1.13.01
HEART LAYERS
59

FIGURE 1.13.02
THE HEART

FIGURE 1.13.03
BLOOD FLOW THROUGH THE HEART

60

FIGURE 1.13.04
IMPULSE SYSTEM OF THE HEART
61

FIGURE 1.13.05
AORTA

62

NAME OF ARTERY AREA SUPPLIED WITH BLOOD LANDMARK

Carotid Arteries

Neck, face, and brain

(1) Pressure point for
bleeding at the neck
(2) Trachea: Carotid pulse
(BLS)

Brachial Arteries

Upper extremities

(1) Pressure point for
bleeding between the middle
and upper part of the arm
(2) Used to take blood
pressure
(3) Brachial pulse in infants

Radial Arteries

Hands

Radial styloid
process: radial pulse

Femoral Arteries

Lower extremities

Pressure point for bleeding
to the lower extremities

Popliteal Arteries

Knee and lower leg

Posterior knee joint
Popliteal pulse

Posterial Tibial Arteries

Lower extremities and foot

Medial malleoulus
Posterior tibial pulse

Dorsalis Pedis Arteries

Foot

Dorsal side of foot
Pedal pulse

TABLE 1.13.01
ARTERIAL LANDMARKS
63

FIGURE 1.13.06
MAJOR ARTERIES AND PRESSURE POINTS
64

FIGURE 1.13.07
CAROTID ARTERY

FIGURE 1.13.08
BRACHIAL ARTERY
65

FIGURE 1.13.09
LOWER EXTREMITY ARTERIES
66
NOTES/COMMENTS

67
Lesson 1.13

The Cardiovascular System Worksheet

1. The prefix ____________ refers to the heart.

2. Vascular refers to ____________________.

3. What are the layers of the heart wall?

a. _________________________________________

b. _________________________________________

c. _________________________________________

4. Which layer of the heart contains the cardiac conduction system? ________________________________

5. The heart receives nourishment through the ______________________.

6. The purpose of the pericardium is to:

a. act as a shock absorber.

b. hold the heart to the sternum.

c. surround and protect the heart.

d. squeeze the heart each time it contracts.

7. Which chamber of the heart receives oxygenated blood from the lungs?

a. Left ventricle

b. Right ventricle

c. Left atrium

d. Right atrium

69


8. List the name, the location and purpose of the four heart valves.

Name Location Purpose

a. __________________ _____________________ _____________________

b. __________________ _____________________ _____________________

c. __________________ _____________________ _____________________

d. __________________ _____________________ _____________________

9. The pulmonary artery carries oxygenated blood away from the heart.

a. True b. False

10. What makes cardiac muscles unique?

a. _________________________________________

b. _________________________________________

11. What is the purpose of the cardiac conduction system?

a. To assure one way flow of blood through the heart.

b. To provide nourishment to the cardiac walls.

c. To assure the cardiac chambers contract in a coordinated manner.

d. To influence the strength of contractions.

12. The __________________ system influences the conduction system.

13. The __________________ system establishes the fundamental rhythm of the heart.

14. List the five components of the conduction system:

a. _____________________________________________________

b. _____________________________________________________

c. _____________________________________________________

d. _____________________________________________________

e. _____________________________________________________

70

15. The conduction system is known as the pacemaker of the heart.

a. True b. False

16. The purpose of the AV node is to:

a. contract the ventricles.

b. speed up the rate of contraction.

c. reduce the volume of blood to the atria.

d. control the pacing of the ventricles.

17. The __________________________, also called the pace maker of the heart, is located in the right atrium.

18. List the three components of the conduction system which ensure ventricular contraction.

a. _____________________________________________________

b. _____________________________________________________

c. _____________________________________________________

19. What is the general purpose of blood vessels?

20. List the types of blood vessels.

a. _____________________________________________________

b. _____________________________________________________

c. _____________________________________________________

d. _____________________________________________________

e. _____________________________________________________

21. Thick-walled vessels that transport oxygen-rich blood to tissues are called:

a. veins

b. arteries

c. arterioles

d. capillaries

22. What type of muscle fibers make up arterial walls?

_____________________________________________________________

71

23. The largest blood vessel in the body is the:

a. great saphenous.

b. aorta.

c. femoral artery.

d. carotid artery.

24. List the four principle divisions of the aorta:

a. _____________________________________________________

b. _____________________________________________________

c. _____________________________________________________

d. _____________________________________________________

25. _____________________________ is the landmark for pulse in infants.

26. The ___________________ is the pressure point for the upper extremities.

a. radial artery

b. subclavian artery

c. brachycephalic artery

d. brachial artery

27. ______________________________ play a key role in regulating blood pressure.

a. Arterioles

b. Arteries

c. Venules

d. Veins

28. The primary function of capillaries is to:

a. repair cell walls.

b. protect the body against infection.

c. communicate impulses to the tissues.

d. exchange nutrients, gases, and wastes between blood and tissue cells.
72


29. The largest portion (60%) of blood in the body is in the:

a. arteries and arterioles.

b. arteries and veins.

c. venules and capillaries.

d. venules and veins.

30. Veins ensure one way flow of blood by squeezing the walls after the blood has passed through.

a. True b. False

31. The mechanisms that promote venous return to the heart are:

a. ______________________________

b. ______________________________

c. ______________________________

32. List the blood vessels that empty the blood into the right atrium.

a. ______________________________

b. ______________________________

33. Trace the flow of blood through the heart.

_______________________________________________________________

_______________________________________________________________

_______________________________________________________________

_______________________________________________________________

34. Trace the flow of blood to the head/neck region.

_______________________________________________________________

_______________________________________________________________

_______________________________________________________________

_______________________________________________________________

73


35. Trace the flow of blood through the upper extremities.

_______________________________________________________________

_______________________________________________________________

_______________________________________________________________

_______________________________________________________________

36. Trace the flow of blood through the lower extremities.

_______________________________________________________________

_______________________________________________________________

_______________________________________________________________

_______________________________________________________________

37. Blood is a living tissue.

a. True b. False

38. List the three functions of blood.

a. _______________________________________________________________

b. _______________________________________________________________

c. _______________________________________________________________

39. The total volume of blood in the body is ________________________________.

40. The liquid portion of the blood is called:

a. erythrocytes.

b. plasma.

c. platelets.

d. leukocytes.

74

41. Antibodies are found in:

a. plasma.

b. tissue.

c. cells.

d. bones.

42. What component of blood gives blood its bright red color in the presence of oxygen?

a. Plasma

b. Hemoglobin

c. Platelets

d. Leukocytes

43. What is the purpose of leukocytes?

_______________________________________________________________

_______________________________________________________________

_______________________________________________________________

44. Clotting of blood is aided by ___________________ in the blood.

75

NOTES/COMMENTS

76

Handbook 1 The Respiratory System
Lesson 1.14

The Respiratory System

Terminal Objectives:

1.14 List the structures of the respiratory system and their basic functions.

ENABLING OBJECTIVES:

1.14.01 Lists and identify the components of the respiratory system and their functions.

The respiratory system works with the
cardiovascular system to supply O2 to the tissues
and remove CO2. The respiratory system
provides for intake of O2, gas exchange, and
elimination of CO2. The actual work of breathing
takes place in the lungs. The rest of the
respiratory system's function is to deliver air to
the lungs.

The nose, or nasal chambers, Figure 1.14.01
and Figure 1.14.02, acts as an entry point for
inhaled air. Here, air is moistened (humidified),
warmed, and filtered. The nasal passage is lined
with hairs and mucous membrane which trap and
filter foreign particles before they can enter the
lungs. The nose also contains receptors for the
sense of smell. The mouth serves as an auxiliary
respiratory structure. The pharynx, or throat, is
part of both the respiratory and digestive systems.
It has a mucous membrane lining to trap foreign
particles, and aids in temperature regulation and
humidification of inhaled air. The pharynx
connects the mouth and nasal chambers
posteriorly. The larynx, or voice box, is located
between the tongue and trachea. It contains the
vocal cords. As air rushes past the vocal cords,
vibrations are set up which, when controlled,
produce speech and singing. Other structures
which aid in speech are the mouth, nose, throat,
bone sinuses, and chest. The epiglottis is a
lid-like structure which covers the larynx. It acts
as a trap door to prevent liquids and particles
from entering the trachea during swallowing.

The trachea, or windpipe, Figure 1.14.02 and
Figure 1.14.03, is a continuation of the
passageway which brings air from the nose/mouth
to the lungs. The trachea is also lined with
mucous membrane cells and tiny hairs which
continue the filtration process. Trapped foreign
material is pushed upward to the pharynx where it
is swallowed or expectorated. The trachea
bifurcates, or divides, into the right and left
bronchi Figure 1.14.03 and Figure 1.14.04, at
about the fifth thoracic vertebrae. The bronchi are
tubes which lead into each lung. The bronchi
continue to divide into smaller and smaller
branches known as bronchioles. Each bronchiole
is surrounded by a cluster of alveoli, Figure
1.14.05. The alveoli are the end point of the
respiratory system. It is here that actual gas
exchange takes place. The alveoli are thin-walled,
sac-like structures surrounded by pulmonary
capillaries. The transfer of CO2 to the blood and
release of CO2 in pulmonary capillaries occurs
across the alveolar and capillary walls.

The lungs consist of a spongy tissue which
functions like elastic when stretched. Each lung is
divided into lobes. The right lung has three lobes,
and the left lung has two lobes. The lungs are
covered by the pleural membrane. The pleural
membrane actually consists of two layers, one
covering the lungs, and one continuous with the
thoracic cavity. A potential space between the
layers is filled with a thin fluid. This fluid allows
77
The Respiratory System Handbook 1
the lungs to glide over the thoracic cavity,
allowing breathing without friction.

The diaphragm is a large, dome-like muscle
separating the thoracic cavity from the abdominal
cavity. It is the primary muscle of respiration.
Contraction of the diaphragm increases the
vertical diameter of the thoracic cavity, causing
inhalation. Relaxation of the diaphragm returns it
to its original shape and causes exhalation. The
intercostal muscles are located between the ribs.
Contraction of these muscles pulls the ribs up and
out, resulting in chest expansion. Relaxation
during exhalation causes the ribs to return to their
original positions.

MECHANICS OF BREATHING

Inhalation and exhalation, or breathing in and
out, occur as the result of pressure differences,
Figure 1.14.06 and Figure 1.14.07. As the lungs
expand during inhalation due to contraction of the
diaphragm and intercostals, the pressure in the
lungs falls below pressure outside the body. A
partial vacuum is created. Air rushes into the
lungs to equalize this pressure difference. When
the diaphragm and intercostals relax, the pressure
inside the lungs becomes greater than that outside
the lungs, air is pushed out of the lungs.

FIGURE 1.14.01
RESPIRATORY SYSTEM
78

FIGURE 1.14.02
UPPER RESPIRATORY SYSTEM
79

FIGURE 1.14.03
RESPIRATORY SYSTEM

FIGURE 1.14.04
LUNGS
80

FIGURE 1.14.05
ALVEOLI
81

FIGURE 1.14.06
MECHANICS OF BREATHING

FIGURE 1.14.07
BREATHING
82
Handbook 1 The Respiratory System Worksheet
Lesson 1.14

The Respiratory System
Worksheet

1. Label the illustration of the respiratory system and use the labels to answer the next nine questions.

83

The Respiratory System Worksheet Handbook 1
2. Filters, warms and humidifies air to body temperature. ___________________________________

3. An auxiliary respiratory structure, which aids in speech. __________________________________

4. Carries air into lungs (hint there is a right and left). ______________________________________

5. Are paired spongy tissues, divided into lobes. ___________________________________________

6. Begins at the lower end of the larynx and divides into right and left bronchi. ___________________

7. Lid-like cover that closes the larynx during swallowing. ___________________________________

8. The primary muscle for breathing. ____________________________________________________

9. Contains the vocal cords. ___________________________________________________________

10. Connects the mouth and nasal chambers. _______________________________________________

84

Basic Hospital Corps School Lesson 1.18 Customer Service and Interpersonal
Handbook 1 Communication

Lesson 1.18

Customer Service and Interpersonal Communication

Terminal Objective:

1.18 Instructional Statement: Customer Service and Interpersonal Communication are
taught using the Navy Medicine Customer Relations training materials, modules 1-5.

Training Goals:

1. Define Navy Medicine's customer relations as it relates to the Mission, Vision, and Guiding principles.

2. Describe how the Navy Core Values can be incorporated into our interactions with customers.

3. Describe the difference between functions of a job and the essence of the job and how they affect people
of the Navy.

4. List the qualities of a "Benchmark" organization.

5. State the significance of "Moments of Truth" and "Coffee Stains."

6. List the three primary principles of Outstanding Customer Relations.

7. Identify potential customers and the different reasons for their behavior.

8. Define how understanding what our customers expect and want is the key to providing Quality Services.

9. Describe how attitude affects the customer's perception of how their needs are being met.

10. List the three areas of the Customer Relations Report Card.

11. Identify the key elements of body language and how they relate to communication.

12. Describe "Active Listening" as a part of communication.

13. List the ways to practice good speaking skills.

14. List the key elements to making a good "First Impression."

15. Identify and address common telephone annoyances.

16. List the proper greeting, holding, transferring and message taking techniques.

17. Identify important listening and speaking concepts.

18. Describe the importance or properly ending a call.
85
Lesson 1.18 Customer Service and Interpersonal Basic Hospital Corps School
Communication Handbook 1

19. List the basic needs of the customer.

20. Describe why customers complain and how complaints affect an organization.

21. Explain why it is important to know why some customers do no complain.

22. Describe how to handle customer complaints.

23. Identify Stress Management Techniques.

86

Navy Medicine: Mission, Vision and Guiding Principles

MISSION:

We are the Medical Department of the United States Navy.
Our mission is to ensure the health of our Sailors and Marines so that they are physically and
mentally ready to carry out their worldwide mission.
We will accomplish this with a comprehensive health promotion program, and when illness or
injury intervenes, we will be there to restore optimal health.
We strive duty members and to all other entrusted to our care.

VISION:

We are committed to providing an environment of health care excellence in which:
All entrusted to our care proudly view Navy Medicine as their preferred source of health care.
Health care professionals view Navy Medicine as a superior arena for realizing their professional
growth and satisfaction.
Health care organizations view the Navy Medical Department as a paradigm of excellence.
Fleet and field commanders view Navy Medicine as fully capable of providing optimal, timely,
and comprehensive health care to their Sailors and Marines worldwide in peace and war.
Our people view themselves as empowered members of the worlds finest health care team.

GUIDING PRINCIPLES:

We will support the combat readiness of the Navy and Marine Corps.
We exist to ensure the best physical and mental health of the men and women of the United States
Navy and Marine Corps. We will:
- Care for all persons as unique human beings worthy of our courtesy, compassion, and
respect.
- Earn the trust and confidence of our patients by enthusiastically providing prompt access to
quality health care.
- Attend to the medical needs of the families of our active duty members, our retirees, and
their families, for just as the family supports the force, so must we support the family.
- Teach, for it is through education that we build the foundation of our future.
- Continuously improve in all aspects of our enterprise.
We care for each other just as we care for our patients. This is the basis of the teamwork and trust
that must exist for us to succeed.
87

Honor, Commitment, Courage

These three Navy Core Values are the very heart of the Navy Medicine, and because they are
incorporated into all our interactions with our customers, Navy Medicine Customer Relations is the
benchmark against which all others are measured.

Honor

We practice the highest ethical standards in all that we say and do. These standards include:

Respecting privacy and confidentiality
Earning personal respect through competence, ownership, dependability, innovation, and creativity
Exhibiting personal excellence by maintaining a professional presentation in attire and manner
Espousing personal integrity while giving polite, attentive, and unique service to all patients and staff
members

Commitment

We are committed to identify, anticipate, and exceed expectations of the patients we serve. This commitment
is achieved by:

Accepting ownership of any problems that come our way
Seeking opportunities to help our colleagues, and always striving to be a team player
Making the extra effort and going the extra mile so that each customer feels important
Pursuing the customers complete satisfaction by providing efficient, courteous service and a clean, safe
environment.

Courage

We will always do the right thing in the face of adversity or distraction. As access-to-care professionals
we:

Acknowledge our errors quickly
Admit to not knowing the answer, and then seek appropriate help
Take the extra steps to please every patient
Remember that every Navy Medicine access-to-care professional is both a role model and a leader
88

Function of Job vs. Essence of Job

Answering the phone, reading memos, processing paper, going to meetings, working on the computer are all
functions of the job. The essence of the job is communicating a polite, caring, attentive, responsive, and
empathetic attitude.

Some people view customers as interruptions to their job. This means the functions are winning out over the
essence of the job and our customers will believe that they have received poor service. The effects of poor
customer relations has a more lasting memory than the momentary anger or frustration felt by the customer.
These feelings of anger, frustration, or resentment often hinge on how satisfied members and their families
are with the services the Navy has provided. We often make decisions based on feelings. If someone
decided to leave because he or she feels dissatisfied with the Navy services, the Navy has lost a valuable
asset. People are the Navys most valuable asset.

Remember that customer relations is first and foremost a mind-set. If you have a positive attitude, understand
that your job is important, and have made a commitment to providing the best possible customer service, you
are on the right path.

What is Navy Medicine Customer Relations?

It is the pursuit of excellence in relating to our customers with:

Honor, Commitment, and Courage!

Politeness goes far, yet costs nothing.
Samuel Smiles, 19 century writer

Moments of Truth

A moment of truth is a situation in which a customer comes into contact with any aspect of the
organization . . . and thereby has an opportunity to form an impression.
J an Carlzon,
President, Scandinavian Air Service

These moments can be positive or negative.

Coffee Stains and Customer Logic

Coffee Stains are negative moments of truth. Coffee stains usually entail leaps of customer logic.
Customer logic allows connections between situations or events that result in an opinion being formed.
An example would be: if you were on a plane and let your lap tray down and saw coffee stains, some
customers would make this connections: If this airline cant keep the tray table clean, how well do they
maintain their engines?

89
Coffee stains set the stage for what people will look for. Remember, if people start out with positive
experiences, they will continue to look for positives to reinforce their first impressions.

The reverse is also true. If people start off with negative experiences, they tend to look for more negatives to
confirm their worst suspicions. We tend to focus on the negatives. Ninety percent of our customers are nice
customers and about ten percent might be considered challenging. Think about that ten percent. When you
see them coming, what goes through your mind? What kind of self-talk is happening? (What we tell
ourselves is what we look for.)

Do you complain and lament about your challenging customers during break with your coworkers? Are you
focusing on the negatives?

You will always get what you expect!

Outstanding Customer Relations. Its not magic, but it does require
These three key ingredients:
1. Know your customers; meet and exceed their needs.
2. Focus on customer service, and do it day in and day out.
3. Have a strong commitment, a determined mind-set, and a positive attitude.

These principles that we use in accomplishing outstanding service are simple, but hey are not easy.
It is not easy to deliver outstanding customer service. It requires a great deal of effort and energy.

We never started out to become 1,000 percent better at anything. Just one percent better at
the thousand different things that are important to the customer. And it worked."

Jan Carlzon
President, Scandinavian Air Service

90
Effective Telephone Communications Skills

Listening and Speaking

There are several important listening and speaking concepts that help to facilitate effective communication.

There are three main levels of effective listening.

Actual spoken words
Implied meaning
Tone, pitch, and feeling of the words

By listening between the line, the callers needs can be better met while reducing the chance
of the caller becoming upset

Effective speaking is equally as important as effective listening.

Give complete attention to the caller.
Answer the callers questions in a positive, concerned manner.
Always speak in a confident and reassuring manner.
When answering questions, give short and accurate answers providing enough detail without
rambling. If you do not know an answer to a question, put the caller on hold and find the answer.
Do not answer questions based on inaccurate information.

Answering the Call: Guiding Principles

1. Answer calls in 3-4 rings
2. The greeting should contain four items:
Department name
Your name
Personalized statement Good Morning
How may I help you?
3. Apologize for delay if more than 3-4 rings

Probably the most important technique associated with telephone use, answering a call can shape how the
rest of the call unfolds. A recent survey showed that over 82% of people said that how the phone is
answered influences their opinion of the company and the answerer. Therefore, it is very important to
answer the phone in a positive, professional, and timely manner. A positive greeting can diffuse a hostile
caller and enable you to answer questions more quickly. This additional time gained by not having a
assist an upset caller can be used to answer other calls and reduce the overall stress of your job.

There are several strategies that should be used in answering a call. First, do not let the phone ring more
than three to four times. The caller is probably already nervous or upset about placing the call in the first
91
place, and letting the phone ring just adds to the callers unpleasantness. If the phone does ring more than
three or four times, apologize to the caller when answering the call. Secondly, have a greeting prepared
when picking up the phone. The greeting should include four basic elements: the hospital/clinic or
department name, the answerers name; a personalized statement such as Good Morning, and How
may I help you? These four elements can be interchanged as to the answerers preference.

Sample Greetings

Good Morning, Patient Affairs,
Pediatrics, Good Morning,
This is Ms. J ohnson This is HM3 Smith
How may I help you? How may I help you?

Good Evening, Good Morning,
Outpatient Records, This is Mr. Olsen
Petty Officer Brown speaking, in the lab,
How may I help you? How may I help you?

Placing a Call on Hold

Using the hold button is an art form that takes certain skills to master. Ideally, a caller should never be placed
on hold. In fact, all telephone users should have the goal of never having to put a caller on hold. However,
there are instances which require the hold feature to used. When placing a caller on hold, there are several
customer relations techniques that should be used:

First, always ask the caller if he/she may be placed on hold by saying Im sorry. May I place you on
hold?

Remember, you are asking the caller a question, therefore you must wait for an answer. Do not assume
that the caller will want to placed on hold. Sometimes the caller just needs to ask a quick question and
may not need to be placed on hold.

Once the caller is on hold, follow the customer relations principle of always keeping the customer
informed.

If the caller is on hold for an extensive period of time, check back with the caller and update with any new
information. Use the callers name when checking back with status reports. If the caller is going to be on
hold for an extensive period of time, offer to call them back or ask the person to call back later.

92

I am sorry; may I place you on hold?

Thank you; it should only be a minute.

Mr. Wilson, I am sorry, but the delay is going to be about 2 more minutes.
Do you mind holding, or should I have someone call you back?

Mr. Wilson, thanks for holding.
Sorry about the delay.
How may I help you?

Transferring a Call

1. Analyze: What does the caller need to know; where does the caller need to go
2. Answer: Answer any questions
3. Apologize: Apologize for transferring, and give extension number
4. Transfer: Transfer the call

Taking a Message

1. Apologize for the need to take message
2. Offer to take message
3. Repeat and clarify information and message
4. Ask when is the best time to call back
5. Ask what can be done in the meantime
6. Thank the caller

Ending the Call

1. Summarize the information discussed
2. Make any final corrections to any messages
3. Close the call on a positive note
Ask what else can be done
Thank the caller
Wish the caller a good day

Interesting Phone Comments

When taking a message for someone who is unavailable, give the caller information he or she needs to know,
(i.e. Lt Smith is in a meeting and will be back at 0930). Do not, however, give out personal information, or
reflect the party being called, yourself, or anyone else in the hospital in a negative light, as the comments
below illustrate.

93

1. Im sorry, Ms. Rogers is still at lunch.

2. I dont know where she is. May I take your number and have her call you?

3. I think he is still having coffee. Ill have him call you when he returns.

4. Hes at the doctors. Im not sure when hell be back.

5. Shes in the middle of a really big customer service problem.

6. He went home early.

7. Im sorry, but Mr. Blue hasnt come in yet.

8. The radiology department takes forever to answer the phone.

9. Look Mister, Im not paid to take this kind of abuse over the phone.

If you always do what youve always done, youll always get
what youve always got.
Anonymous

People dont care how much you know,
until they know how much you care!

First and foremost, people want to deal with people who care. They do not want to be a number waiting for
service; they want to be treated as a unique individual. If we keep in mind that all of us wear an invisible sign
that says I want to be important, appreciated, and admired. Then we have a framework in which to
communicate in a positive way to all those with whom we come into contact.

Communication Techniques

Person-to-person

Understand and be able to use body language as a communication tool
Demonstrate how to make a positive first impression. Demonstrate listening skills
Identify and overcome barriers to communication

94

Telephone

Understand effective telephone communication skills
Practice telephone techniques

Difficult Situations

Demonstrate the key steps for dealing with difficult situations
Identify stress management techniques

Your Message

Body Language

Facial Expressions
Eye Contact
Physical Distance
Touch
Postures and Gestures
Appearance

WARNING: Remember that body language is not an exact science, but there are
general rules that will help us to communicate with each other
more effectively.

95
Body Language

Physical Distance
Zones: Intimate- family, friends, children
significant others

Personal- customers

Social- teachers

Cultural Note: Latin Americans and Middle Easterners tend to stand closer together;
whereas Asians, especially Japanese, tend to stand further apart than most
North Americans and Europeans.

Touch
In general, we know that touch is essential to our overall well-being. We also know that
cultural influences are important in determining what is proper and under what
circumstances.

WARNING: Always be sensitive to the other persons reaction to touch. If you touch a person,
and he or she moves or pulls away, he or she is trying to tell you something. Let this be your
cue not to touch him or her again.

Listening Skills

What traits does a good listener have?
______________________________________________________
______________________________________________________

96
What are the barriers to effective listening?
_____________________________________________________________________
_____________________________________________________________________

Excellence is an art won by training and habituation. We are what we repeatedly do.
Excellence, then, is not an act but a habit.
--Aristotle

Listening Tips

Relax; take a deep breath and clear your mind
Avoid distractions
Listen for intent as well as content
Dont overreact emotionally to speakers words
Dont prejudge customer because of age, looks, voice or demeanor
Dont assume you know what the customer wants
Write down important facts

Active Listening

Attentive body language
Verbal attends (i.e., uh-huh)
Open-ended questions
Restate the key point(s)

Its not what you say but what is heard.
Its not what you show but what is seen.
Its not what you mean but what is understood.
Perception is reality.

Lisa Ford, Customer Service Consultant

97
Speaking Sills

Avoid medical jargon
Ask questions to understand and clarify
Use tone and infection to show care and concern

Build rapport by using gestures, words, and vocal patterns that are similar to those of your customer. If your
customer speaks slowly, you should try to slow down your rate of speech. Likewise, if your customer does
not use many gestures, try to reduce your gestures. This technique is based on Neurolinguistic Programming
(NLP). You are to some degree mirroring their body and voice patterns. Do not do this to the point of
mimicking. It should be done subtly with the purpose of establishing rapport. Your customer should not even
be aware of what you are doing. However, the results will be that the customer instinctively begins to like
you and feel comfortable with you. This makes it easier to do your job.

Magic Phrases

Please Thank You

Youre Welcome Im Sorry

98
Domino Exercise

Making A Good First Impression

First impressions are formed in the first 20 seconds of an encounter.

Look the part of a professional

Greet immediately

Use body language to acknowledge the patient visually and verbally

Use tone and inflection to express care and concern

End on an appropriate warm note:
Thank you
Hope youre felling better
Enjoy the rest of the day

99
Dealing with Difficult Situations

Before a discussion on dealing with difficult situations can begin, we should first examine what our customers
want and need. The following explains those needs. Essentially, our customers want:

Friendly interactions Customers come to your department hoping and expecting to trust you and your
coworkers. They like those providing service to be friendly, warm, and caring. They want their interactions
to be as pleasant as possible.

Understanding and Empathy Customers want to feel like someone understands or cares what they are
feeling. They want you, the service provider, to show empathy and concern for them.

Fairness Customers want to feel like they are being treated fairly. They want to be assured that neither rank
nor seniority will interfere with the quality and timeliness of service provided. They want to feel that theyre
receiving the same level of treatment and degree of competence as everyone else.

Some Degree of Control Patients are often placed in situations where they or their family members feel
helplessat the mercy of someone else. In addressing these feelings, health care providers must help patients
feel as though they are active and intelligent participants in the decisions that affect them.

Options and Alternatives Customers want to know that there are several options and alternatives available
to them when making decisions about their care. As part of the participatory process, they should be given
available options.

Information Customers like to be kept informed about situations that directly affect them. Keeping them in
the dark could lead to frustration and, in some extreme cases, anger. It is also a violation of their rights as
patients.

Customers want to be taken Seriously and be Respected When problems or concerns arise, customers
want to feel like they are being seriously considered and with respect.

Consequently, when a customer feels as though his or her need was not met, one of two things generally will
occur. The customer will either go away upset, frustrated, or angry. Or, he/she may lodge a complaint
against the offending individual or organization.

Customers normally complain because of:

Dissatisfaction with the Quality of Service This could be from waiting for extended periods on the
telephone; inability to find parking; unavailability of immediate appointments; waiting too long in the lobby
after arrival for an appointment; lost records; lost blood work etc.

Dissatisfaction with the Quality of Care This relates directly to the physical/mental care that the patient
receives. A customer could be dissatisfied with a diagnosis of a problem, with treatment/medicine received,
or with the service given by the medical staff.

Customer did not get what was promised As customer service providers, we must ensure that we do not
promise our customers a service or product that we can neither provde nor make available.

100
Unrelated Event At times a customers complaint may not have any direct relationship to the individual or
organization providing the immediate service. The customer could be dealing with other issues, such as
concern about a medical problem, concern about the health/well being of a loved one, or the customer may be
having a bad day.

Other reasons customers complain include:

Staff projected a cant-do attitude

Staff was rude to customer

Customer felt indifference from the staff

Customer felt that no one was listening

The average person who has a complaint tells 9 to 10 people about their experience.
Those customers whose complaints have been resolved tell 5 to 6 people.

Not every customer is willing to complain when he or she has a problem. Research has shown that: 4 % of
unhappy customers complain; 96% just go away angry. For every customer complaint received, there are an
average of 26 more people with problems; six of those are severe. Of those who complain, 56%-70% will do
business with you again, if the complain is resolved. 96% if it is resolved quickly.

There are several reasons why customers dont complain.

First, some customers are afraid of retaliation. Others think that it takes too much time. There are also those
customers who feel that its not nice to complain, while others think that nothing will be done or that their
problem isnt important. Finally, customers dont complain because they dont know to whom they should
complain.

So, what should you do when you encounter a customer who has a complaint, either in person or on the
telephone? How do you handle a disappointed or angry customer in a face to face or telephone situation?

101
Successful Complaint Handling

When you encounter an unhappy or an angry customer there are several key procedures that should be used to
diffuse the situation.

1. Let the customer vent Let the customer express his or her feelings. (a) Dont try to avoid the
customers venting by trying to go directly to solving the problem. (b) See the problem through the
patients eyes. Remember, if you want to effect the complainer you need to understand the power of their
point of view and feel the emotional force with which they believe. Separate the problem from the
person Dont allow yourself to become overwhelmed by the individual. At all cost (a) avoid becoming
defensive, even if the complaint is about you. Additionally, (b) dont fuel the fire by using phrases such
as Its not my problem, or Its not my responsibility. Avoid Emotional Outburst If you encounter
an angry or aggressive customer, maintain your composure. Dont try to prove them wrong. Temper
your interaction. If the situation appears to getting uncontrollable or violent, seek help immediately.

2. Listen without interruption When receiving a complain, it is important to listen without interruption
give the individual your undivided attention. (a) Restate the problem when the individual is finished.
Ensure that the customer is confident that you understand the problem. (b) Ask questions to clarify points
or issues. Research the Problem If you did not receive enough information from your customer
initially, ask additional questions. Who, what, where, when, why, and how? should cover information
needed to make the next step.

3. Express empathy and apologize Using phrases like, I understand what you are going through, or I
understand how frustrating this must be, is a good way to convey that you understand the customers
situation. Empathy also means saying Im sorry. Apologizing is not admitting guilt. It just conveys
that you are sorry that the customer has an unfortunate experience.

4. Find out what the customer wants When a customer complains about a situation, dont jump to
conclusions about how they wish to have the situation rectified. Find out how you may improve the
situation for the customer.

5. Discuss options with the customer At this point, both you and the customer should try to come up
with a course of action to resolve the situation. Although the solution may be obvious, allow the
customer to suggest possible solutions.

6. Act or hand off to someone who can help When you receive a complaint, it becomes your
responsibility. Take ownership of the situations until it has been satisfactorily rectified. If you are unable
to solve the problem, ensure that the proper channels receive the complaint and are working to rectify it.

7. Keep the customer informed Inform the customer of your authority and capability to solve the
problem. Let him/her know why you may have limited authority to act.

8. Follow up Whenever possible follow up with the customer or appropriate department. Find out if:
The problem was correctly addressed
The problem was handled in a timely manner
The solutions were helpful.

9. Thank the person for bringing the situation to your attention.

10. Finally, ask if there is anything else you can do for the customer.
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What To Do When You Cant Say Yes

These are times when we are unable to meet a patients needs. We may have to say no because of the law,
military rules and regulations, or department policies and procedures. Other times we may be forced to say
no simply because it is just impossible to meet the customers needs. Although the customers needs were not
met, he or she could still be made to feel as though they received the best possible service. To ensure this,
here are some helpful tips on how to effect the situation. These principles mirror those used when dealing
with difficult situations.

1. Listen Give the customer the opportunity to speak freely and without interruptions.

2. Give a friendly response nod, or use the appropriate tone and inflection if you are on the telephone

3. Empathize and apologize show that you understand the situation and you are sorry for their frustration
and pain.

4. Educate give the customer information, letting him/her know why you are unable to meet the request.

5. Look for options give the customer other alternatives; invite the customer to work with you in
identifying other options.

6. End on a warm note although you were unable to assist the customer with the original request, let
him/her know that you are available to assist them in the future. For example, upon ending the
conversation, use a phrase such as, I am sorry I was unable to help, but if I could be of further assistance,
please dont hesitate to let me know.

103
Emotional Trigger Words

No No, I cannot let you see your medical file. Nothing turns customers off faster than a flat no
without explanation or without hearing them out.

Policy Thats our policy. Patients translate policy into inflexibility and resistance. They feel
that the policy takes precedence over their needs.

I cant The doctor cant see you on Tuesday. Patients would like to hear what can happen rather
than what cannot. For example, I am sorry; the earliest available appointment is Wednesday
morning.

They They require us to This phrase is frustrating to the patient who will never meet they.
Instead patients like to hear I and we. This indicates that the front-line service provider cares and
takes at least some responsibilty for the problem the patient is experiencing.

The computer The computer canceled your appointment; I didnt. Computers are only tools,
incapable of thinking on their own. Take responsibility for computer malfunctions and empathize
with the patient instead. For example, I am sorry; I am unable to find your appointment; let me see
if I can arrange for you to be seen anyway.

Examples of phrases that should be avoided and substitutions that would make the
communication process more effective.

Avoid using: Use this instead:

You did this wrong! There are a few areas on this form

If the customer made an error, point out the mistake indirectly. He or she may be embarrassed by the
mistake and may try to blame you instead.


You did this wrong! I can see theres been a
misconnection.

Do not openly accuse the customer. If you have to explain what went wrong, use the indirect approach
or statements using I as much as possible.


You must Will you.. please
Could you please..?

People like to be given choices. Ask them to do something, or explain why it would be beneficial
for them to do something. Dont TELL them to do it.


Stay here. Would you mind waiting here while
I check on that information?
104
Stress Management

What is stress? Stress is a physical and emotional reaction to change. It can be positive or negative. It is not
the changes themselves but our reaction to those changes or events that determines if we feel stressed.

The first step to managing stress is to identify your stressors, those things that make you react. Stressors
come from many sources work, expectations, or family members, and the pressure we place on ourselves to
perform.

What makes you feel stressed?

The events that trigger your stress and your reaction to stressful situations are unique to you. Public speaking
may be thrilling for you, but for the next person, the experience may be a terrifying as standing in front of a
firing squad. Simply by being aware of your stress triggers may lower your stress by helping you identify
changes you can make.

At some point in our lives, we all will experience varying levels of stress. In order to help us better prepare
for these, there are several things you may wish to incorporate in your daily activities.

Control your thoughts. When you are under stress your body needs an increase in vitamins and minerals. Of
particular value are all the B vitamins and vitamin C. Decreasing the amount of caffeine and refined sugar in
your diet is also beneficial. Drink at least eight glasses of water a day and use alcohol in moderation.

Exercise! You should exercise aerobically at least three times a week for at least 20 minutes. This means get
your heart rate up.

Rest Your body needs rest. J ust how much varies from person to person, but most of us need six to eight
hours of sound sleep a night.

Practice relaxation techniques Prayer, meditation, deep breathing exercises, and yoga, to name a few, are
all forms of relaxation. There are many more. Find one that suits you and apply it.

Play! Do something you enjoy other than work.

Balance your life. This means incorporating all the above into your daily activities.

105
NOTES/COMMENTS

106
Basic Hospital Corps School Lesson 1.10 Anatomy and Physiology
Handbook 1 The Musculoskeletal System
Lesson 1.10

The Musculoskeletal System

Terminal Objective:

1.10 List the structures of the musculoskeletal system and explain their basic functions.


1.10.01 List the types of bone tissue and explain their functions

1.10.02 List and describe the types of bone shapes.

1.10.03 List and identify the divisions of the skeleton and explain their functions.

1.10.04 List and identify the structure of the axial skeleton and explain their functions.

1.10.05 List and identify the structures of the appendicular skeleton and explain their functions.

1.10.06 List the classifications of joints and their functions

1.10.07 List the characteristics of skeletal muscle tissue.

1.10.08 List the functions of skeletal muscle tissue.

1.10.09 List the types of movements performed by muscles and joints.

1.10.10 List and identify selected muscles and explain their functions.

The musculoskeletal system is made up of
muscles, ligaments, tendons, and bones. All
bones are made of calcium, phosphorus, and other
mineral salts, plus an organic substance called
ossein. The mineral salts provide strength and
hardness.

There are two types of bony tissue: compact
and cancellous. Compact bone, with its
concentric ring structure, forms a bone's solid
outer shell and protects the spongy layer. It
provides nourishment, helps in bone growth and
repair, and provides a surface for attaching
tendons and ligaments. The spongy layer includes
bone marrow and cancellous bone. The
cancellous layer is usually found in short, flat,
irregularly shaped bones. It has an irregular
latticework structure, providing a storage area for
red marrow which produces blood cells.

Bones are classified by shape. Long bones
are longer in length than in width. Examples of
long bones are the femur and humerus. The femur
is the longest and strongest bone in the body and
is found in the thigh. The humerus is the long
bone of the upper arm. Short bones are short in
length and are found in the wrist and ankle. Flat
bones are rather thin bones that form the skull or
cranium, sternum or breast bone, and scapula or
shoulder blade. Irregular bones do not fit into any
other category, examples are vertebrae and
mandible.
107
The Musculoskeletal System Handbook 1
The skeleton, Figure 1.10.01, has two
divisions: axial and appendicular. The axial
skeleton consists of the skull, vertebral column,
and the thorax. The skull bones are further
divided into the cranial and facial bones. The
appendicular skeleton is made up of the bones
of the upper and lower extremities. The skeleton
supports and gives shape to the body, protects
vital organs, provides places for tendons, muscles,
and ligaments to attach, serves as a means to
accomplish movement, stores mineral salts, and
produces blood cells.

AXIAL SKELETON

SKULL

The skull provides protection for the brain,
eyes, ears, nasal, and oral structures, Figure
1.10.02. With the exception of the lower jaw bone
(mandible) and the ear bones, all skull bones are
joined together in a fixed position. The seams
where they join are known as sutures. The
frontal bone forms the forehead. The two
parietal bones form the roof of the skull. The
two temporal bones, which help form the sides
and base of the skull, also house the hearing
organs. The occipital bone forms part of the base
and back of the skull and contains a large hole,
the foramen magnum, which permits passage of
the spinal cord from the cranium into the spinal
column. Facial bones, Figure 1.10.03, form the
upper and lower jaw, nasal walls, and the eye
socket, known as orbits. These bones contain
large cavities called sinuses. When these sinuses
become infected, the individual experiences much
discomfort. The lower jaw is called the mandible.
Its main function is mastication. It is the only
bone of the skull that moves. The maxilla forms
the upper jaw. The cheekbones are known as
zygomatic bones.

VERTEBRAL COLUMN

The spinal or vertebral column is made of 33
irregular bones which are divided into five
regions: cervical (neck), thoracic (chest), lumbar
(lower back), and sacral and coccygeal (pelvic),
Figure 1.10.4.

The vertebrae protect the spinal cord and the
nerves arising from the spinal cord and provides
support for the body.

There are seven cervical vertebrae in the
neck, Figure 1.10.04 and Figure 1.10.05. The first
is called the atlas, C1. It resembles a bony ring
and supports the head. The second is the highly
specialized axis, C2. It has a bony prominence
that fits into the ring of the atlas, thus permitting
the head to rotate from side to side. The seventh
cervical vertebra, C7, has an especially prominent
projection that can easily be felt at the nape of the
neck. This makes it possible for health care
providers to count and identify the vertebrae
above and below it.

There are 12 vertebrae in the thoracic region
which help protect the internal organs. These
articulate with the posterior portion of the 12 ribs
to form the posterior wall of the thoracic, or chest
cage.

There are five lumbar vertebrae; these are the
largest segments of the vertebral column, Figure
1.10.06. The sacrum is a triangular bone which is
formed by the fusion of five false vertebrae near
the end of the spinal column. It articulates on
each side with the hip bone and with the coccyx
to form the posterior wall of the pelvis. The
coccyx is the triangular bone at the end of the
spinal column which is made of three fused
bones, sometimes called the tailbone.

THORAX

The thorax is a cone-shaped bony cage,
about as wide as it is deep, Figure 1.10.07, which
protects the heart and lungs. It is formed by 12
ribs on each side, which articulate posteriorly
with the thoracic vertebrae. The first seven pairs
of ribs are attached to the sternum by cartilage
and are called true ribs. The eighth, ninth, and
tenth ribs are united by their cartilage to the
cartilage of the seventh rib and are called false
ribs. The last two ribs are not attached to the
sternum and are called floating ribs.

The sternum is an elongated flat bone,
forming the middle portion of the upper half of
the anterior chest wall. The xiphoid process,
108

located at the inferior aspect of the sternum,
serves as a landmark in cardiopulmonary
resuscitation.

APPENDICULAR SKELETON

The appendicular skeleton consists of the
bones of the upper and lower extremities.

UPPER EXTREMITIES

The upper extremity consists of the shoulder
girdle, arm, forearm, wrist, and hand, Figures
1.10.08, 1.10.09, and 1.10.10. The bones that
form the framework for the upper extremity are:

Clavicle -- collar bone
Scapula -- shoulder blade
Humerus -- arm bone
Radius and Ulna -- forearm bones
Carpals -- wrist bones
Metacarpals -- bones of the palm
Phalanges -- finger bones

SHOULDER GIRDLE

The clavicle, Figure 1.10.09, forms the front
part of the shoulder girdle. It lies nearly
horizontal immediately above the first rib and is
shaped like a flat letter S.

The scapula is a triangular bone that lies in
the upper part of the back on both sides, between
the second and seventh ribs, forming the posterior
portion of the shoulder girdle. Its lateral corner
forms part of the shoulder joint, articulating with
the humerus.

The humerus is the longest bone of the upper
extremity. It articulates with the shoulder girdle to
form the shoulder joint and with the bones of the
forearm to form the elbow.

When the arm is in the anatomical position
with the palm turned forward, the radius, Figure
1.10.10, is on the lateral, or thumb, side and the
ulna is on the medial, or little finger, side of the
forearm. The radius is an anatomical location for
the radial pulse. The ulna and the radius articulate
at their proximal ends with the humerus, at their
distal ends with some of the carpal bones, and
with each other at both ends.
There are eight carpal bones, arranged in two
rows, forming the wrist, Figure 1.10.11

The metacarpal bones form the palm of the
hand. Each upper extremity has five metacarpal
bones.

The small bones of the fingers are called
phalanges. Each finger has three bones, except
the thumb, which has two. The bone at the end of
the finger is called the distal phalanx; the one
closest to the hand is called the proximal phalanx;
and the one in between is called the middle
phalanx.

LOWER EXTREMITIES

The lower extremity includes the hip, thigh,
leg, ankle, and foot, Figures 1.10.12. The bones
that form the framework of the lower extremities
are:

Innominate -- hip bone
Femur -- thigh bone
Patella -- knee cap
Tibia -- leg bone
Fibula -- leg bone
Tarsals -- ankle bones
Metatarsals -- foot bones
Phalanges -- toe bones

PELVIC GIRDLE

The hip, or innominate bone, is a large,
irregularly shaped bone composed of three parts:
the ilium, ischium, and pubis, Figure 1.10.13. In
children these three parts are separate bones, but
in adults they are firmly united to form a cup-like
structure into which the head of the femur fits.
The ilium forms the outer prominence of the hip
bone (crest of the ilium), the ischium forms the
hard lower part, and the pubis forms the front
part of the pelvis.

The two pubic bones are joined with cartilage
known as the symphysis pubis which is used as
an anatomical reference point.

109
The crest of the ilium is used in making
anatomical and surgical measurements, e.g.,
location of the appendix, which is approximately
halfway between the crest of the ilium and the
umbilicus.

The femur or thigh bone, Figure 1.10.13, is
the largest and strongest bone of the body. It fits
into the pelvic girdle.

The patella, or kneecap, Figure 1.10.14, is a
small oval-shaped bone overlying the knee joint.
It is enclosed within the tendon of the quadriceps
muscle of the thigh. Bones like the patella that
develop within a tendon are known as sesamoid
bones.

The tibia, or shinbone, is the larger of the two
leg bones and lies on the medial side of the lower
leg. The proximal end articulates with the femur
and the fibula. The distal end articulates with the
talus (one of the foot bones) and the fibula. A
prominence easily felt on the inner aspect of the
ankle is known as the medial malleolus.

The fibula, the smaller of the two leg bones,
is located on the lateral side of the leg, parallel to
the tibia. The prominence at the distal end forms
the outer ankle, known as the lateral malleolus.

The tarsus, or ankle, is made of seven bones.
The largest, strongest tarsal bone is the calcaneus
(heel bone).

The foot bones are known as metatarsus
bones.

The phalanges are the bones of the toes and
are similar in number, structure, and arrangement
to the bones of the fingers.

JOINTS

Wherever two bones are attached to each
other, a joint is formed. In a freely movable joint,
such as the knee or elbow joint, the ends of the
bones are covered with a smooth layer of
cartilage. The whole joint is enclosed in a
watertight sac or membrane containing a small
amount of lubricating fluid. This enables the joint
to work with little friction. Since this fluid is
called synovial fluid, the joints are also known as
synovial joints. J oints are classified according to
the amount of movement they permit, Figure
1.10.15, They may be:

Immovable. Bones of the skull are rigidly
interlocked along immovable joint lines known as
sutures.

Slightly movable. In these joints, the bones
are held together by broad flattened disks of
cartilage and ligaments, e.g., vertebrae and
symphysis pubis.

Freely movable. Such joints include the
knee, hip, and shoulder. These joints are further
subdivided into:

Hinge joints. Elbow and knee.

Ball-and-socket joints. Shoulder and hip.

Ligaments attach bone to bone and cross
joints to keep them from getting out of place.
Muscles are attached to bones by tendons.
Ligaments, tendons, and muscles work together to
allow movement.

MUSCLES

Characteristics

Skeletal muscles are primarily attached to
bones. They are characterized as voluntary
muscle because they can be made to contract or
relax by conscious control. Muscles make up
about half of the total body weight. Muscles have
four principal characteristics:

1. Excitability -- the ability to respond to
certain stimuli by producing electrical signals
called impulses.

2. Contractility -- the ability of muscle tissue to
shorten and thicken to generate the force to
do work.

3. Extensibility -- the ability of muscle to
extend or stretch without being damaged.
110

Most muscles are in pairs, as one contracts
the other extends.

4. Elasticity -- the characteristic of muscles
tending to return to their original shape after
contraction or extension.

Contractility enables a muscle to become
shorter or thicker, and this ability, along with
interaction with other muscles, produces
movement in internal and external body parts.
Muscle contraction in a tissue or organ produces
motion and provides power and speed for body
activity. Muscular tone, or tonicity, gives muscles
a certain firmness, or a continual state of partial
contraction. Isometric muscle contractions occur
when the muscle is stimulated and shortens, but
no movement occurs, as when a person tenses his
or her muscles against an immovable object.
Muscles are also capable of stretching when force
is applied and regaining their original form when
that force is removed. Isotonic muscle
contractions occurs when the muscle is
stimulated. The muscle shortens and movement
occurs. An example of this would be lifting a
object off a table. The chemical action of muscle
fibers consists of two stages, contraction and
recovery. In the contraction stage two protein
substances (actin and myosin) react to provide
energy. In the recovery stage oxygen and
glycogen are used to provide energy and to react
with lactic acid, which releases carbon dioxide
and water.

Functions

1. Provide movement.

2. Maintain body posture through muscle tone,
as in the muscles of the head, neck, and
shoulders, which keep the head up.

3. Provide heat through chemical changes that
take place during muscle activity, such as
mild exercise that warms the body on cold
days, shivering when you are cold.

Movements

A. Flexion -- decreasing the angle of a joint,
e.g., forearm toward upper arm.

B. Extension -- increasing the angle of a joint,
e.g., forearm away from upper arm.

C. Abduction -- moving a body part away from
the midline, e.g., arm extended away from body.

D. Adduction -- moving a body part toward the
midline, e.g., arm released back to body.

E. Supination -- moving the forearm so the
palm is turned upward. The elbow must be flexed
to 90 degrees, otherwise movement is from the
shoulder.

F. Pronation -- moving the forearm so the palm
is turned downward. The elbow must be flexed to
90 degrees, otherwise movement is from the
shoulder.

G. Eversion -- twisting outward, as in turning
the sole of the foot outward.

H. Inversion -- twisting inward, as in turning the
sole of the foot inward.

MAJOR MUSCLES

Major, superficial muscles, Figure 1.10.16,
include:

The masseter muscle is located in the lower
jaw and functions to raise the mandible. The
deltoid muscle is located on the lateral side of the
humerus and its function is to raise the arm. It is
the site of choice for small amounts of
intramuscular injections. The Biceps brachii are
prominent muscles on the anterior aspect of the
arm. The triceps brachii are the primary
extensors of the forearm and are located on the
posterior surface of the humerus. The gluteus
maximus is the large muscle of the buttocks. It
extends and laterally rotates the thigh and is the
site of choice for intramuscular injections.

111
The quadriceps femoris is a group of
four muscles that make up the anterior portion of
the thigh. Their function are to extend the leg and
flex the thigh. The biceps femoris muscles make
up posterior portion of the thigh, and are
commonly known as the hamstring. They flex the
leg and extend the thigh.
FIGURE 1.10.01
112


FIGURE 1.10.02
SKULL LATERAL VIEW

FIGURE 1.10.03
SKULL LATERAL VIEW
113

FIGURE 1.10.04
BONES OF THE SPINE

FIGURE 1.10.05
CERVICAL VERTEBRAE
114

FIGURE 1.10.06
VERTEBRAL COLUMN

FIGURE 1.10.07
BONES OF THE SPINE

115

FIGURE 1.10.08
BONES OF THE ARMS & SHOULDERS
116

FIGURE 1.10.09
SHOULDER GIRDLE

FIGURE 1.10.10
SHOULDER GIRDLE
117

FIGURE 1.10.11
BONES OF THE WRIST & HAND
118

FIGURE 1.10.12
BONES OF THE LOWER EXTREMITY
119

FIGURE 1.10.13
PELVIC GIRDLE

FIGURE 1.10.14
PELVIC GIRDLE
120

FIGURE 1.10.15
PELVIC GIRDLE
121

FIGURE 1.10.16
PELVIC GIRDLE
122
Handbook I The Musculoskeletal System Worksheet
Lesson 1.10

The Musculoskeletal System
Worksheet

1. What type of bony tissue forms the solid outer shell of a bone?

a. Cancellous

b. Compact

2. What is the function of cancellous tissue?

____________________________________________________________________________

____________________________________________________________________________

3. List two examples of a flat bone.

a. ___________________________

b. ___________________________

4. The vertebra is an irregular type bone.

a. True b. False

5. The appendicular skeleton consists of what bones?

a. _____________________________________________

b. _____________________________________________

6. List the functions of the skeleton.

a. ______________________________________________

b. ______________________________________________

c. ______________________________________________

7. The axial skeleton consists of the __________________________ , ____________________ and
_______________________________.

123
The Musculoskeletal System Worksheet Handbook I
8. The skull only provides protection of the brain.

a. True b. False

FOR THE NEXT THREE QUESTIONS, REFER TO THE FOLLOWING ILLUSTRATION.

9. Letter A refers to the _________________________ bone.

10. Letter B refers to the _________________________ bone.

11. The function of the bone, at letter C is _________________________ .
.

124
FOR THE NEXT FIVE QUESTIONS, REFER TO THE FOLLOWING ILLUSTRATION.

12. Letter A refers to the __________________________ region.

13. Letter C refers to the __________________________ region.

14. Letter D refers to the __________________________ region.

15. Letter B articulates with 12 ribs to form the __________________________ cage.

16. Letter E is the ________________________ which is formed by three fused false vertebrae.

125
THE NEXT FIVE QUESTIONS RELATE TO THE FOLLOWING ILLUSTRATION.

17. Letter A shows the ________________________________ .

18. Letter B shows the ________________________________ .

19. Letter C shows the ________________________________ .

20. Letter D is known as the _____________________________ girdle.

21. Letter E shows the _________________________________ .

126
22. What is the strongest and largest bone of the body?

a. Humerus

b. Femur

c. Tibia

d. Ulna

23. What joints are held together by broad, flattened disks of cartilage and ligaments?

a. Slightly movable

b. Immovable

c. Movable

d. Highly movable

24. What are the functions of muscle? __________________________________________________

25. The muscle movement that occurs when increasing the angle of a joint is known as:

a. flexion.

b. extension.

c. abduction.

d. adduction.

26. Define inversion. ________________________________________________________________

27. The site of choice for small amounts of intramuscular injections is the ______________________
muscle.

28. The large muscle of the buttocks, which is the site for intramuscular injections is the
______________________ muscle.

127
NOTES/COMMENTS

128
Handbook 1 The Integumentary System
Lesson 1.09

The Integumentary System

Terminal Objective:

1.09 List the structures of the integumentary system and their basic functions.


1.09.01 List and identify two major layers of the integumentary system.

1.09.02 List the composition of the two major layers of the integumentary system.

1.09.03 List and identify the structures within the dermis and their functions.

1.09.04 List the accessory structures of the integumentary system.

Layers of the Integumentary System

The surface area of the skin in an average
adult is about 3000 square inches. Classified as an
organ, the skin has a very complex structure,
which allows it to perform functions necessary for
our survival.

There are two principal parts which compose
the skin, the epidermis and the dermis.

The outer, thinner portion is called the
epidermis. Attached to the dermis, the epidermis
is composed of epithelial cells that are tough, flat,
and scale--like. This outer layer of skin protects
the underlying structures from injury, drying, and
invasion by foreign organisms.

Cells in the epidermis, called a melanocytes,
produce melanin. Melanin is a pigment. It gives
skin color and absorbs ultraviolet light.

The underlying layer of skin called the
dermis, or true skin, is composed of connective
tissue embedding blood vessels, hair follicles,
nerve endings, smooth muscles, and sweat and oil
glands. Fibers of tissue in the dermis extend
downward and gradually blend into deeper tissue,
anchoring the skin to other underlying tissues and
organs.

Dermis tends to be thicker in dorsal regions,
thinner in ventral regions; thicker on the outer
aspects of the extremities than on the inner
aspects. The dermis is thick in the palm of the
hand and the sole of the foot, and very thin in the
eyelids, penis, and scrotum.

Structures within the Dermis

Three major tissue structures are found in the
dermis. Blood vessels, glands, and nerve endings
are contained in spaces between coarse elastic
fibers that give the dermis a dense, connective
physical characteristic. These fibers interlace in a
netlike manner.

Blood vessels in the skin can dilate to contain
a significant portion of the body's blood supply.
Changes in blood volume contained in the skin
can affect a person's blood pressure. Body
temperature can be regulated by the
integumentary system by: 1) adjustment of blood
flow to the skin, and 2) evaporation of sweat from

129

The Integumentary System Handbook 1
the skin surface. This leads to a loss of heat from
the skin surface to the outside atmosphere.

Three types of glands are associated with the
skin. 1) Sweat (sudoriferous) glands assist in the
maintenance of body temperature by producing
perspiration. Perspiration also helps to eliminate
wastes. The amount of perspiration varies
depending on temperature, humidity, and
exercise. In lower environmental temperatures,
sweat production is decreased to maintain body
heat. 2) Sebaceous (oil) glands produce sebum,
which keeps hair from drying out and becoming
brittle. Sebum forms a protective film that
prevents excessive evaporation of water, keeping
skin soft and pliable. It also inhibits the growth of
some bacteria. Sebaceous glands are usually
connected to hair follicles. 3) Ceruminous
glands are modified sweat glands that are simple,
coiled tubular glands in the external auditory
canal. They secrete cerumen (ear wax) providing
a sticky barrier that prevents the entrance of
foreign bodies.

Nerve endings called Meissner's corpuscles
extend upward from the dermis into the
epidermis. Responsible for touch, they carry
impulses to and from the central nervous system
(CNS).

Accessory Structures of the
Integumentary System

Structures formed during the embryonic stage
of development, such as fingernails and hair,
perform necessary, and sometimes vital,
functions.

Finger and toe nails are hard keratin. Keratin is a
protein that is water proof, resistant to friction and
helps repel bacteria. Nails are found in the top
layer of the epidermis. These structures form a
clear and solid cover over the dorsal surface of
the distal portion of fingers and toes. Functions of
nails include: 1) protecting many sensitive nerve
endings at the end of the digits, and 2) allowing
us to grasp and manipulate objects in numerous
ways.

Hairs are growths of epidermis distributed
with wide variation which cover almost every part
of the body. The primary function of hair is
protection, but specific functions of hair vary
depending upon the anatomical location.

Hair, together with the cerumen in the
external and internal ear canal, provides a sticky
barrier to protect from the entrance of foreign
particles into the ear. This protective mechanism
aids in the function of hearing.

Nasal hair acts as a filter for inhaled particles
such as dust, insects, and pollen. It assists with
moisturizing the air we breathe.

The hair of our eyelashes and eyebrows help
to protect our eyes from coming into close contact
with most foreign particles.

Scalp hair provides limited protection from
injury and /or the sun's harmful rays.

Under the influence of stressors, such as
fright, cold, or emotions, smooth muscles found
in the dermis, called the erectores pilorum
muscles, pull the hairs into a vertical position.
Contraction of the erector pili muscles causes hair
to stand upright. The raised skin around the hair
shaft is more commonly known as a Goosebump.

130

Handbook I The Integumentary System Worksheet
Lesson 1.09

The Integumentary System Worksheet

1. The pigmentation of the skin, located in the epidermis, is called ______________.

2. Blood vessels, hair follicles, nerve endings, and sweat glands are found in the ______________.

3. Match the physiologic functions in column B to the structure that performs the function in column A.
Answers may be used more than once.

A B

a. Blood vessels __________

b. Sweat glands __________

c. Sebaceous glands __________

d. Nerve endings __________

e. Epidermis __________

f. Dermis __________

1. Protects underlying structures from injury, drying, and
invasion by foreign organisms.

2. Expand and contract to control body temperature.

3. Help maintain body temperature.

4. Gradually blends into the deeper tissue.

5. Provide cooling by producing perspiration.

6. Inhibits growth of some bacteria.

7. Keep hair from drying out.

8. Carry impulses to and from the central nervous system.

4. Hair covers almost every part of the body.

a. True b. False

5. Hair has no specific function.

a. True b. False

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The Integumentary System Worksheet Handbook 1

6. Nails protect the nerve endings of digits.

a. True b. False

132

Handbook 1 The Nervous System
Lesson 1.11

The Nervous System

Terminal Objective:

1.11 List the structures of the nervous system and their basic functions.


1.11.01 List and identify the components of the nervous system and their functions.

1.11.02 List and identify the structures of the nervous system and their functions.

1.11.03 List and identify the structures of the peripheral nervous system and their functions.

1.11.04 List the functions of the autonomic nervous system.

To support human life, the activities of the
widely diverse cells, tissues, and organs of the
body must be monitored, regulated, and
coordinated. The interaction of the nervous and
endocrine systems provides this control.

The nervous systems is specifically adapted
for the rapid transmission of impulses from one
area of the body to another. The endocrine
system, working at a far slower pace, maintains
body metabolism at a fairly constant level.

In this section the structure and functions of
the nervous system will be presented.

COMPONENTS OF THE NERVOUS
SYSTEM

The central nervous system consists of the
brain and spinal cord, Figure 1.11.01. The brain is
almost entirely enclosed in the skull, and is
connected to the spinal cord, which lies in the
canal formed by the vertebral column.

The peripheral nervous system is the
portion of the nervous system outside the brain
and spinal column. It carries voluntary and
involuntary impulses. The primary functions of
the peripheral nervous system are to carry
information from the body to the central nervous
system AND carry information from the central
nervous system to the rest of the body.

NEURONS

The structural and functional unit of the
nervous system is the neuron, or nerve cell. A
neuron is composed of dendrites, a cyton, and an
axon, Figure 1.11.02. Dendrites are thin,
receptive branches which in different types of
neurons vary greatly in size, shape, and number.

They serve as receptors, conveying impulses
toward the cyton. The cyton is the cell body
containing the nucleus. The single, thin extension
of the cell outward from the cyton is called the
axon. It conducts impulses away from the cyton
to its terminal filaments, which transmit the
impulses to the dendrites of the next neuron.

There are three types of neurons. The first is
the sensory neuron, which conveys nerve
impulses from sensory receptors in the body
(eyes, ears, skin, etc.) to the brain. The second is
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The Nervous System Handbook 1
the motor neuron, which carries command
impulses from the brain and spinal cord to the
muscles or glands. The third type is the
interneuron, which links the sensory neurons to
the motor neurons.

BRAIN

The brain has two main divisions, the
cerebrum and the cerebellum, Figure 1.11.03.

The cerebrum, Figure 1.11.04, is the largest
and most superiorly situated portion of the brain.
It occupies most of the cranial cavity. Its primary
purpose is higher mental processes such as
memory. The outer surface is called the cortex
and is known as gray matter. This layer is
responsible for sensory skills, such as hearing and
sight. The cortex interprets incoming data by
relating to past experiences. The medulla is the
innermost layer of the cerebrum and is known as
white matter. This layer is responsible for motor
skills. It also supports life maintenance functions
such as regulating blood pressure and respiration
rate.

The cerebrum is subdivided into lobes, each
servicing a localized, specific brain function. The
frontal lobe is associated with the higher mental
processes such as memory. The parietal lobe is
involved primarily with general sensations. The
occipital lobe is related to the sense of sight. The
temporal lobe is concerned with hearing.

The cerebellum is situated posterior to the
brain stem and inferior to the occipital lobe. It is
chiefly associated with bringing balance,
harmony, and coordination to movements
initiated by the cerebrum.

The brain stem consists of the mid-brain,
pons, and medulla oblongata. The mid-brain,
located in the brain stem, contains the
hypothalamus which regulates body temperature
and the pituitary gland which influences most
other glands. Located below the mid-brain, the
pons consists chiefly of a mass of white fibers
connecting the cerebrum, cerebellum, and
medulla oblongata. The pons works with the
medulla to control respiration and relays impulses
for some of the cranial nerves. The medulla
oblongata is the inferior portion of the brain, the
last division before the beginning of the spinal
cord. It connects to the spinal cord at the upper
level of the first cervical vertebra (C-1). It
controls heart action, breathing, circulation, and
other vital processes such as blood pressure.

SPINAL CORD

The spinal cord, Figure 1.11.05, is continuous
with the medulla oblongata and extends from the
foramen magnum, inferiorly through the atlas, to
the lower border of the lumbar region. The spinal
cord is surrounded by the bony walls of the
vertebral column. The spinal cord does not
completely fill the vertebral canal and it does not
extend the full length of it. The nerve roots
serving the lumbar and sacral regions pass some
distance down the canal before exiting. The spinal
cord conducts sensory and motor communication
between the brain and the body parts. It also plays
an integral role in the autonomic nervous system
and in the reflex arc, both of which will be
discussed later
The spinal cord is similar to an electrical
Cable containing many wires (nerves) that
connect parts of the body with each other and
with the brain. Sensations received by a sensory
nerve are brought to the spinal cord where the
impulse is transferred either to the brain or to a
motor nerve. The majority of impulses go to the
brain for action. However, a system exists for
quickly handling emergency situations. It is called
the reflex arc.

PROTECTIVE MECHANISMS OF
THE CENTRAL NERVOUS SYSTEM

The cranium, or skull, is the structure that
houses and protects the brain from trauma such as
blows and falls. The surface of the brain and
spinal cord are covered with three layers of
membrane called meninges. The dura mater is
the strong outer layer, the arachnoid membrane
is a delicate middle layer, and the pia mater is
the innermost layer that adheres to the surface of
the brain and spinal cord. Inflammation of the
meninges is called meningitis. The type of
meningitis depends upon whether the brain, spinal
cord, or both are affected.
134
Cerebro-spinal fluid (CSF) is the clear, watery
fluid that surrounds the brain and spinal cord. It
provides a protective cushion and a means of
exchanging nutrients and waste products.

PERIPHERAL NERVOUS SYSTEM

The peripheral nervous system is composed
of 12 pairs of cranial nerves arising from the brain
and 31 pairs of spinal nerves arising from the
spinal cord. The peripheral nervous system carries
voluntary and involuntary impulses. The
hypothalamus and medulla oblongota are its
major control centers. There are two major
divisions of the peripheral nervous system.

The somatic nervous system is the
peripheral nervous systems voluntary circuit and
is composed of the input from hearing, taste, etc.
This information is processed by the brain and
results in voluntary or consciously controlled
skeletal movements. For example, you are
grocery shopping and see something you would
like to buy. The brain processes the input from
the eyes carried to it via the sensory neurons. The
brain then makes a decision Pick up that item and
put it in the shopping cart). That impulse is
carried from the brain along the motor neurons to
the appropriate skeletal muscles. The result is that
you pick up the item and put it in your shopping
cart.

The autonomic nervous system, as its name
implies automatically regulates bodily functions
(involuntary). It is NOT under conscious control
of the brain. The autonomic nervous system
regulates cardiac muscle that controls heart
contractions, smooth muscle movement that
controls gastrointestinal muscles and glandular
secretions like insulin.
The sympathetic division is responsible for
the fight or flight reaction which coordinates
the body's reaction to stressful situations, such as
danger or strenuous physical activity. The
sympathetic division induces changes in the body,
such as:

1. Increasing heart rate, blood pressure, and blood
sugar level

2. Dilating the pupils

3. Constricting peripheral blood vessels

4. Stimulating the adrenal gland to produce
epinephrine and nor-epinephrine, hormones that
prolong the effects of the fight or flight reaction.

The parasympathetic division works to
conserve and restore the body's energy. It helps to
return the body to normal functioning by:

1. Decreasing heartbeat

2. Lowering blood pressure

3. Stimulating gastrointestinal movement and
secretions, which aid in the absorption of
nutrients

4. Constricting pupils

5. Dilating peripheral blood vessels

6. Emptying the bladder and bowels

The sympathetic and parasympathetic
divisions work together, counterbalancing each
other, to preserve the harmonious equilibrium of
bodily functions.

135

FIGURE 1.11.01
CENTRAL NERVOUS SYSTEM

FIGURE 1.11.02
NEURON
136

FIGURE 1.11.03

Oblongata
FIGURE 1.11.04
BRAIN
137

FIGURE 1.11.05
THE SPINAL CORD
138
Handbook 1 The Nervous System Worksheet
Lesson 1.11

The Nervous System Worksheet

1. The basic structural and functional unit of the nervous system is the _____________________________

2. List the three basic types of neurons.

a. ________________________________________________________________________________

b. ________________________________________________________________________________

b. ________________________________________________________________________________

3. The basic function of the interneuron is to inform areas of the cerebral cortex and send message to move
body parts.

a. True b. False

4. List the two main divisions of the brain.

a. _______________________________________________________________________________

b. _______________________________________________________________________________

5. What is the basic function of the cerebrum?

__________________________________________________________________________________

6. What layer of the cerebrum is responsible for sensory skills such as sight and hearing?

__________________________________________________________________________________

7. List the four major lobes of the cerebrum.

a. ______________________________________________________________________________

b. _______________________________________________________________________________

c. _______________________________________________________________________________

d. _______________________________________________________________________________

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The Nervous System Worksheet Handbook 1

8. Which lobe of the cerebrum is responsible for memory?

a. Parietal

b. Frontal

c. Occipital

d. Temporal

9. Which lobe of the cerebrum is responsible for the sense of sight?

a. Parietal

b. Frontal

c. Occipital

d. Temporal

10. What is the bridge between the cerebrum, cerebellum, and medulla called?

a. Medulla oblongata

b. Pons

c. Spinal cord

d. Cranial nerves

11. What regulates vital functions such as heartbeat, breathing and blood pressure?


b. Pons

c. Spinal cord

d. Cranial nerves

12. What conducts impulses to and from the brain?


b. Pons

c. Spinal cord

d. Cranial nerves

140

Handbook 1 The Nervous System Worksheet

13. List the protective mechanisms of the central nervous system.

a. __________________________________________________________________________________

b. __________________________________________________________________________________

c. __________________________________________________________________________________

14. The peripheral nervous system conveys information from the periphery of the body to the central nervous
system.

a. True b. False

15. List the functions of the autonomic nervous system.

a. __________________________________________________________________________________

b. __________________________________________________________________________________

16. Explain the fight or flight reaction which prepares the body for stressful situations.

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

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The Nervous System Worksheet Handbook 1
NOTES/COMMENTS

142

Basic Hospital Corps School Lesson 1.21 Vital Signs
Handbook 1
Lesson 1.21

Vital Signs

Terminal Objective:

1.21.1 Take, record and report vital signs.


1.21.01 Define terms related to vital signs.

1.21.02 List environmental factors and state how they influence vital signs.

1.21.03 List the normal vital sign values for the average adult.

1.21.04 List the types of clinical thermometers.

1.21.05 List equipment used to take blood pressure.

1.21.06 List guidelines for assessing a patient's vital signs, including taking a temperature, pulse, respiration
rate, blood pressure, and pain assessment.

1.21.07 List the procedure for assessing orthostatic hypotension.

1.21.08 List the guidelines to record temperature, pulse, respiration, and blood pressure, and pain level.

1.21.09 Locate selected pulses.

1.21.10 Assess a patient's vital signs by taking temperature, pulse, respiration rate, blood pressure, and pain
assessment.

1.21.11 Record temperature, pulse, respiratory rate, blood pressure, and pain level.

Vital signs are probably the most crucial skills
learned by Hospital Corpsmen. Fortunately, they
are among the easiest to learn. Accurately obtaining
and interpreting temperature, pulse, respiration, and
blood pressure measurements (abbreviated T, P, R,
B/P) are imperative to properly care for patients.
These four diagnostic signs can provide rapid
insight into the patient's condition. Any level of
pain can influence vital signs and is included as the
5
th
vital sign in an assessment.

As a Hospital Corpsman, you will take vital
signs frequently. It is always important to be
accurate when obtaining, recording, and
interpreting vital signs. A patient's life may depend
upon your observations. There are many terms
related to vital signs that you will use often; here is
a basic list.

143
Lesson 1.21 Vital Signs Basic Hospital Corps School
Handbook 1
TEMPERATURE

1. Temperature -- measurement of the amount
of heat below the skin and subcutaneous tissues.

2. Fever -- elevated body temperature.

3. Febrile -- with fever.

4. Afebrile -- without fever.

5. Hypothermia -- body temperature which is
below the normal range.

6. Hyperthermia -- body temperature which is
above the normal range.

PULSE

1. Pulse -- regular, recurrent expansion and
contraction of an artery produced by waves of
pressure caused when the heart beats.
Sensation can be felt when fingertips lightly
compress an artery against an underlying bone.

2. Tachycardia -- abnormally rapid heart beat,
above 100 in the adult.

3. Bradycardia -- abnormally slow heart beat,
below 60 in the adult.

4. Thready pulse -- a weak and rapid pulse.

5. Bounding pulse -- an unusually strong pulse.

6. Arrythmia -- pulse which is irregular in
rhythm.

RESPIRATION

1. Inhalation -- act of taking air into the lungs.

2. Exhalation -- act of expelling air out of the
lungs.

3. Dyspnea -- labored or difficult breathing.

4. Apnea -- absence of breathing.

5. Tachypnea -- excessively rapid breathing.
6. Respiration -- exchange of gasses between
the atmosphere, blood, and body cells.

BLOOD PRESSURE

1. Blood pressure -- force that the circulating
blood exerts against the artery walls as the
heart contracts and relaxes.

Blood pressure is recorded as two separate
pressures: systolic and diastolic pressure.

a. Systolic pressure -- highest peak pressure
exerted on arterial walls during ventricular
contraction. Ventricular emptying occurs at
this time.

b. Diastolic pressure -- the pressure exerted
on the arterial walls during ventricular
relaxation. Ventricular filling occurs at this
time.

2. Hypotension -- abnormally low blood
pressure. Hypotension may cause insufficient
perfusion of internal organs.

3. Hypertension -- abnormally high blood
pressure. Hypertension may cause rupture of
the arteries and destruction of organs.

4. Perfusion -- flow of blood through tissues
providing them with oxygen, nutrients, and
removal of waste products.

Factors Which Influence Vital Signs

Vital signs fluctuate throughout each day, and
change at various ages. Activity, emotions, age,
drugs, and eating are all factors that affect
temperature, pulse, respiration, blood pressure, and
pain level.

Exercise, eating, anger, and stimulant drugs
(such as caffeine and nicotine) increase T, P, R, and
B/P. Vital signs are decreased by rest, depression,
and depressant drugs (such as pain relievers). Some
medications (such as antihypertensives) are
designed to specifically raise or lower blood
pressure. Pain usually increases blood pressure,
temperature, pulse, and respiration.
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Handbook 1
Children have higher pulse and respiration
rates than adults do. Blood pressure is lower in
children than in adults.

Values For Vital Signs

Temperature

Oral 98.6 degrees F.
(37 degrees C.)

Rectal 99.6 degrees F.
(37.5 degrees C.)

Axillary 97.6 degrees F.
(36.5 degrees C.)

Tympanic 98.6 degrees F.
(37 degrees C.)

Pulse

60-100 beats per minute.

Respiration

12-20 breaths per minute. (Adult)

20-40 breaths per minute. (Child)

Blood Pressure

Systolic: 90 to 140 mm Hg.

Diastolic : 60 to 90 mm Hg.

Abnormal Readings

When vital signs readings are outside the
normal values, they deserve extra attention.
Abnormal readings for temperature, pulse,
respirations, and blood pressure should be repeated
to ensure that the abnormal values are not due to
faulty technique. Always notify the nurse for any
abnormal readings. Temperatures of 100 degrees or
higher are circled in RED when documented.

Clinical Thermometers

A clinical thermometer is used to measure
body heat. Three common types of clinical
thermometers are:

Glass thermometers, made of a hollow glass
stem and bulb filled with either mercury or alcohol,
Figure 1.21.01. The fluid expands with heat and
rises up the tube. Clinical thermometers are
calibrated in the Fahrenheit or Centigrade scale. A
long line is marked on the stem for every degree
Fahrenheit, separated by short lines marked every
0.2 degrees. Degrees are also marked on Centigrade
thermometers using long lines, separated by short
lines representing 0.1 degree.

Glass thermometers have an arrow located at
98.6 degrees F (37 degrees C) to indicate the
average oral temperature. Fahrenheit thermometers
are the most common. For accurate measurement,
the fluid must be below 94 degrees F before taking
a temperature.

Oral and rectal thermometers each have two
distinguishing characteristics. Oral thermometers
have a long, slender bulb, and are color-coded blue.
Rectal thermometers have a short, stubby bulb and
are color-coded red.

Electronic thermometers have a read-out unit
and sensing probes used to obtain oral, rectal, and
tympanic temperatures. Measurements are
displayed after only a few seconds. When the read-
out unit sounds a beep, the temperature will be
displayed on a screen. Disposable plastic probe
covers prevent the spread of infection. A new
plastic cover is used each time a temperature is
taken.

Electronic thermometers may have permanent
or disposable batteries. They are stored in a
recharging unit (permanent batteries) or base unit
(disposable batteries). Unless the thermometer is
returned to the base or recharging unit per
manufacturer's instructions, it will stop working.

Tympanic thermometers use an infrared sensor
to detect the temperature of blood flowing through
the ear. Corpsmen frequently use tympanic
thermometers for critically ill patients, infants, and
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Handbook 1
children. Without rousing the patient, a quick,
accurate temperature is obtained.

Heat sensitive patch or tape change color
when used on the forehead to measure a patient's
temperature. A reusable patch or tape will change
color at different temperature ranges. These devices
display a number when heated to different
temperature ranges.

Tapes and patches are the least accurate
method of taking a temperature. They should be
used in accordance with local policy. A patch or
tape may be used at home to tell if a child needs to
be seen by a health care provider. In the operating
room, anesthesia personnel use patches and tapes
for an ongoing visual display of patient
temperature.

Equipment Used to take Blood Pressure

Two standard pieces of equipment are used to
take blood pressure. One is the stethoscope and the
other is the sphygmomanometer.

The stethoscope is an instrument that transmits
sound from the patient's body to the examiner's
ears, Figure 1.21.02. It consists of rubber or plastic
ear tips, rubber or plastic tubing, and a chest piece
containing a diaphragm and a bell.

The sphygmomanometer is used to measure
blood pressure. Three types of
sphygmomanometers are: mercury, aneroid, and
electronic, Figure 1.21.03.

Mercury and aneroid sphygmomanometers
have a bladder that is inflated with air when taking
a blood pressure. The bladder is surrounded by a
cuff that is placed around the patient's arm. Two
tubes are attached to the bladder, one leading to the
mercury chamber or gauge, and the other to the
inflation bulb.

The bulb us pumped manually, filling the
bladder with air. A needle valve attached to the
bulb is regulated by the examiner. When closed to
inflate the bladder, the needle valve traps air in the
bladder. When open, the needle valve allows air to
escape while blood pressure is being measured.

The glass tubes on mercury
sphygmomanometers and the gauges on aneroid
sphygmomanometers are calibrated in increments
of 2 millimeters of mercury (2 mm Hg). Each small
line represents 2 mm Hg and each large line 10-mm
Hg.

Electronic sphygmomanometers have the same
cuff, bladder, and tubing as do other
sphygmomanometers. Instead of a bulb, electronic
measuring devices have an electronic pump and a
digital display. Units operate on batteries, usually
the type that must be recharged. Between uses, the
unit has to be plugged in to continue functioning.
To operate an electronic sphygmomanometer, the
corpsman places the cuff around the patient's arm
and presses a button to start the machine. The
bladder automatically inflates. When there is
enough air in the bladder, inflation stops, and
deflation begins. Blood pressure and pulse are
displayed digitally when the unit beeps.

Procedures for Taking Vital Signs

Any patient procedure requires proper
identification. Three checks are done; at the bed
tag, at the identification bracelet, and by asking the
patient to state his/her name. Using the principles of
medical asepsis, the corpsman washes his/her hands
before each patient contact. Provide for patient
education, privacy, safety, and comfort.

Ensure the patient has had nothing to eat or
drink (hot or cold), has not been physically active,
and has not been smoking for at least 15 minutes.
(15-30 minutes is even better). An acronym such as
SEED (smoking, eating, exercising, and drinking)
or LEDGES (laughing, eating, drinking, gum
chewing, exercising, smoking) is a good way to
remember what to ask the patient.

Temperature

The usual order for taking vital signs is
temperature, pulse, respiration, and blood pressure.
To take a temperature, make sure the patient is in a
sitting or a lying position. For oral temperature
readings with an electronic thermometer, use the
blue probe. Slide a disposable plastic probe cover
onto the sensing probe and place it in the patient's
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Handbook 1
mouth, with the bulb in the pocket at the base of the
tongue, Figure 1.21.04. Instruct the patient to close
his/her lips. Hold the probe in place until the unit
beeps. When the unit beeps, the temperature will be
displayed. Remove and discard the disposable
probe cover. Replace the probe cover in the unit.

Rectal temperatures are taken with the red
probe. Slide a disposable cover onto the probe.
Place water-soluble lubricant on a piece of tissue
and lubricate the sensing probe cover. Instruct the
patient to lie on the left or right side with the upper
leg flexed. Drape the patient so that only the
buttocks are exposed. Don clean gloves. Separate
the patient's buttocks, exposing the anal opening,
Figure 1.21.05. Insert the sensing probe
approximately 1 1/2 inches into the rectum of an
adult (insert only 1-inch into the rectum of an
infant). Hold the probe in place until the read--out
unit beeps, then remove the probe from the rectum.
When the unit beeps, the temperature will be
displayed. Remove and discard the disposable
probe cover. Replace the probe cover in the unit.

To take an axillary temperature, follow the
same procedure for taking an oral temperature,
except place the plastic covered sensing probe in
the center of the axilla with the forearm across the
chest, Figure 1.21.06 Hold the probe in place until
the read-out unit beeps, then remove the probe from
the axilla. When the unit beeps, the temperature
will be displayed. Remove and discard the
disposable probe cover. Replace the probe cover in
the unit.

Tympanic temperatures are taken by following
the general guidelines for electronic thermometers
above. After applying the probe cover, gently insert
the sensing probe into the auditory canal. Hold the
probe in place until the read-out unit beeps, then
remove the probe from the ear. When the unit
beeps, the temperature will be displayed. Remove
and discard the disposable probe cover. Replace the
probe cover in the unit.

When using a clinical thermometer that has
been stored in a chemical solution, remember to
wipe off any drops, rinse with water, and wipe dry.
Shake down the thermometer below 94 degrees if
this has not been done. A glass thermometer may be
covered with a plastic sheath.
Glass thermometers are left in place 3-5
minutes for oral, 3-5 minutes for rectal, and at least
10 minutes for axillary readings.

To read a glass thermometer, hold it
horizontally at eye level and turn it slowly until the
line can be seen clearly.

Oral temperatures are contraindicated in
children under six years of age, patients who are
mouth breathers, individuals who have had oral or
nasal surgery, or patients who are unconscious or
irrational.

Rectal temperatures are contraindicated when
a patient has had rectal or perineal surgery, those
with diarrhea, and in infants.

Pulse

To take a pulse, make sure your patient is in a
sitting or a lying position. If the patient has been out
of bed or active, wait 10-15 minutes for the pulse to
return to its resting level. Then determine the pulse
site to be used.

The radial pulse is the most frequently
checked pulse during routine vital signs. Locate the
radial pulse on the thumb side of the wrist. The
most common site used for infants and toddlers is
the brachial artery located on the medial side of the
antecubital space. Other sites include the temporal
in front of the ear, the carotid located on the side of
the neck, femoral located in the groin, dorsalis
pedis on top of the foot, posterior tibialis posterior
to the medial malleolus, and the apical which is
slightly below the level of the nipples to the left of
the sternum.

The pulse in your thumb will mask the
patient's pulse. Never use your thumb for taking a
pulse.

When taking a pulse, pay attention to
characteristics such as rate (the number of beats per
minute), strength (weak, strong, steady, or
bounding), and rhythm (regular or irregular).

Count a pulse for 30 seconds and multiply the
result by two. A pulse should be counted for 60
seconds when the pulse is abnormal. This includes
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Handbook 1
pulses that are irregular or difficult to feel. Patients
with cardiac or cardiovascular problems should
have their pulse counted for 60 seconds. Infants and
children need to have a 60-second pulse count also.

If the peripheral (usually the radial) pulse is
difficult to feel, use the apical site. To take an
apical pulse, place the stethoscope on the chest
slightly below the level of the left nipple. The apex
of the heart should be approximately at the fourth
intercostal space. Count each lub-dub as one beat.

Respiration

To measure the respiration rate, make sure the
patient is in a sitting or a lying position. If the
patient has been out of bed or active, wait 10-15
minutes for breathing to return to its resting level.

Count each rise and fall of the chests as one
respiration. Respirations are counted for 30 seconds
and multiplied by two. When there is an abnormal
rate, rhythm, depth or sound, count the respirations
for 60 seconds. Note the characteristics of
breathing, including, rate (the number of
respirations per minute), rhythm (regular or
irregular), depth (shallow or deep), and sound.
Normal respirations have soft, breezy inspiration
and short, low pitched expiration. Abnormal
respirations are described as stertorous (or snoring),
moist, or gurgling.

Blood Pressure

Since blood pressure can be affected by
activity and emotions, delay taking a reading if the
patient is upset, in pain, or has just exercised. Blood
pressure can be taken by auscultation (listening) or
by palpation (feeling). Readings can be taken from
the arm or the leg. Most often, you will take blood
pressure from the arm.

Select a blood pressure cuff that is the
appropriate size for your patient. The average adult
cuff fits the arm, and is approximately 12-14 cm
(4.5-5.5 inches) wide. Various sizes are available,
fitting the range from premature infant to an adult
thigh. Electronic sphygmomanometers come with a
set of cuffs covering common sizes. Wards and
clinics typically have larger and smaller cuffs
available for use.

To take a blood pressure, make sure your
patient is in a sitting or a lying position. If the
patient has been out of bed or active, wait 10-15
minutes for blood pressure to return to its resting
level.

Position the cuff on the arm with the cuff
midway on the arm over the brachial artery, Figure
1.21.07. When the cuff is deflated, the gauge should
read zero. Ensure that the tubing is not kinked.
Wrap the cuff snugly around the arm. Make sure
that no clothing interferes with placement of the
cuff. The lower edge of the cuff will then be 2.5-5
cm (1-2 inches) above the antecubital space (the
inner aspect of the elbow). Support the forearm at
the level of the heart, with the palm of the hand
facing up. On the leg, the cuff is placed over the
back side of the mid-thigh. If the cuff has an
indicator mark, align it with the artery you will use
to measure the blood pressure.

Blood Pressure by Auscultation

Palpate the brachial pulse with two or three
fingers of one hand. With the other hand, close the
needle valve screw on the blood pressure cuff.
Pump the bulb slowly to inflate the cuff. Observe
the point at which the pulse can no longer be
palpated. Deflate the cuff. Wait 15 seconds before
reinflating the cuff.
Place stethoscope ear pieces in ears with tips
facing forward. With firm gentle pressure, place
stethoscope diaphragm directly over the brachial
artery where the pulse was palpated. Do not allow
stethoscope diaphragm to touch clothing or cuff.
If the diaphragm or tubing rub other objects, the
listener will hear extra sound, called artifact,
which makes it harder to hear the sounds of a
patient's heat beat.
Close the needle valve screw on blood pressure
cuff. Pump the bulb slowly to inflate cuff. Inflate
cuff until gauge reads 30 mm Hg higher than the
point where the pulse could not longer be palpated.
Loosen the needle valve screw, releasing pressure.
Allowing the pressure to drop slowly, 2-4 mm Hg
per second.
The first distinct sound heard is the systolic
pressure. (Listen for the first clicking or tapping
148
Handbook 1
sound). Continue to release the pressure slowly.
The point at which the last sound disappears is the
diastolic pressure
It is possible to hear sounds all the way to zero
with some patients, especially children. Vigorous
exercise, faulty technique, and some disease also
may cause sound to be heard to zero. If you hear
sounds to zero, wait at least a minute, then retake
the blood pressure, listening carefully for a point at
which the sound decreases or becomes muffled.
Always repeat any suspicious readings.

Blood Pressure by Palpation

Position the patient in a sitting or lying
position, and place the cuff the same as for
auscultated blood pressures. Palpate the patient's
brachial pulse, or, if necessary, the radial.
Maintain finger placement, close the needle valve,
and inflate the cuff to the point where you can no
longer feel the pulse. Note this point, and continue
to inflate 30 mm Hg higher.
Release the pressure slowly, 2-4 mm Hg per
second. Watch the gauge as you feel for the return
of the pulse. The reading on the gauge when the
pulse returns is the systolic blood pressure, by
palpation.

Blood pressure by palpation is taken when the
corpsman does not have a working stethoscope.
When the background noise is too loud, as in an
ambulance or a helicopter, blood pressure by
palpation may be the only way to obtain a reading.

Electronic (sometimes called non-invasive)
blood pressure devices are operated according to
their manufacturer's instructions. Select and apply
the cuff the same way as in the manual technique.
The cuff is inflated by pressing the appropriate
button. Inflation and deflation take several seconds,
followed by display of the values in the read-out
panel.

Assessing Orthostatic Hypotension

Orthostatic hypotension is defined as a rapid
decrease in blood pressure related to a change in
position from lying to sitting or sitting to standing.
The normal change in systolic blood pressure
tends to be no more than 15 mm Hg lower than the
reading taken in a reclining position. Diastolic
blood pressure may rise or fall 10 mm Hg, or stay
the same.

Changes (decreases) in systolic blood pressure
greater than 15 mm Hg, and diastolic blood
pressure greater than 10 mm Hg indicate that the
patient has orthostatic hypotension.

Orthostatic hypotension is commonly seen in
patients with chronic circulatory problems such as
hypertension and vascular disease. Orthostatic
hypotension is also seen in dehydrated patients
(causes include vomiting, diarrhea, and
diaphoresis). It can be seen as a side effect to
medication, possibly diuretics or anti-hypertensives.

The patient will typically complain of
dizziness or light-headedness, and may faint. Most
often this occurs shortly after changing to a more
upright position, as when you attempt to ambulate
the patient.

An accurate assessment requires that the
corpsman take two or more blood pressure
measurements. Have the patient lie supine for at
least three minutes, and take a blood pressure. Have
(or assist) the patient sit at the edge of the bed for
three minutes, and repeat the blood pressure. Have
the patient stand, wait three minutes, and take a
third blood pressure. As an alternative, you make
elect to do only two readings, which should be
lying to either sitting or standing.

When you have all the values, compare to
determine the amount of variance between readings.
Be alert to the patient's condition between readings.
Be alert to the patient's condition. Dizziness and
fainting are always possible.

Pain Assessment
Ask an adult patient if he/she is in pain. If
yes, ask: What causes the pain? How would you
describe it? Use the Numerical Rating Scale
(NRS) Figure 1.21.08 to assess the level of pain. To
use the rating scale, ask the patient, On a scale, of
0-10 with 0 being no pain and 10 being the worse
pain imaginable, where is your level of pain?

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Handbook 1
Pulses are assumed to be radial unless
otherwise indicated. Most pulse sites are spelled
out. An exception is the apical pulse, which is
abbreviated AP.

Recording Vital Signs

Blood pressure readings are recorded as a
fraction, with systolic over diastolic. Example:
120/80. Blood pressure by palpation is recorded as
systolic over P. Example: 110/P. Thorough
documentation will include the patient's position
(standing, sitting, or lying) and the extremity used.

All vital signs are recorded in the patient's
chart. Vital Signs Record SF 51, Plotting Chart SF
512, Chronological Record of Medical Care, SF
600, or a local form or flow sheet may be used.

Temperatures 100 degrees F or higher are
circled in red. Note the route used. The oral route is
assumed unless otherwise indicated. Document
other routes as follows: R for rectal, A for axillary,
and T for tympanic.
All abnormal vital signs are reported to the
nurse or doctor, and documented accurately.

FIGURE 1.21.01
A. ORAL THERMOMETER
B. ORAL THERMOMETER
C. RECTAL THERMOMETER

150
Handbook 1

a. Ear Pieces
b. Rubber Tubing
c. Diaphragm
d. Bell
FIGURE 1.21.02
STETHOSCOPE

FIGURE 1.21.0 SPHYGMOMANOMETERS
151
Handbook 1

FIGURE 1.21.04
PLACEMENT OF ORAL THERMOMETER

FIGURE 1.21.04
PLACEMENT OF RECTAL THERMOMETER
152
Handbook 1
153
FIGURE 1.21.06
PLACEMENT FOR AXILLARY
TEMPERATURE
Handbook 1

FIGURE 1.21.07 FIGURE 1.21.07
Handbook 1
154
PLACEMENT OF SPHYGMOMANOMETER
154
Handbook 1

FIGURE 1.21.08
155
Basic Hospital Corps School Lesson 1.21 Vital Signs Worksheet
Handbook 1

Lesson 1.21

VITAL SIGNS WORKSHEET

1. Match each definition in column B to the correct medical term in column A.

A B

a. Orthopnea __________

b. Afebrile __________

c. Perfusion __________

d. Hypertension __________

e. Dyspnea __________

f. Fever __________

g. Systolic Pressure __________

h. Bradycardia __________

i. Arrhythmia __________

1. An abnormally slow heart beat below 60 in the
adult

2. Labored or difficult breathing

3. The period when maximum pressure is exerted
on the arterial walls during a heart beat

4. An elevated body temperature

5. A condition in which breathing is easier
when the patient is in a sitting or standing
position

6. The flow of blood through tissues, providing
Them with oxygen and nutrients and removing
Waste products

7. Without fever

8. A pulse which is irregular in rhythm

9. An abnormally high blood pressure

2. A rectal thermometer has a ___________________bulb and is color coded ___________ on the end.

3. An oral thermometer has a ________________ bulb and is color coded _________________on the end

4. The small lines on a thermometer indicate _______________ F.

5. The electronic thermometer is stored in a _______________ when not in use.

6. The arrow on a glass thermometer indicates _______________________.

7. The glass thermometer must register below _______ F before use.

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Lesson 1.21 Vital Signs Worksheet Basic Hospital Corps School
Handbook 1

8. Identify the parts of the stethoscope

A. ________________

B. ________________

C. ________________

9. Identify which blood pressure cuff is mercury and which is aneroid.

a. _____________________________ b. _____________________________

10. Indicate whether each factor would increase or decrease T,P,R and B/P.

a. Anger

b. Rest

c. Old aged.

d. Exercise.

e. Depression

f. Eating.

g. Pain relief.

h. Nicotine and caffeine

11. Children tend to have a/an ________________ pulse and respiration rate than adults.

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Basic Hospital Corps School Lesson 1.21 Vital Signs Worksheet
Handbook 1

12. Fill in the normal range and average for the following temperatures.

a. Rectal Average __________________________

Normal range ______________________

b. Oral Average __________________________

Normal range ______________________

c. Axillary Average __________________________

Normal range ______________________

13. Answer each of the following True or False.

a. The normal adult range for pulse is 70-110 beats per minute.

b. The normal child's pulse is 100-120 beats per minute.

c. The normal adult range for respiration is 16-20 breaths per minute.

d. Respiratory rate in children is slower.

e. The American Heart Association considers a systolic pressure up to 140 mm/Hg normal in ages 20-40
years and up to 160 mm/Hg in people over 40 years old.

f. Systolic blood pressure in females is normally 10 mm/Hg higher than males.

g. Diastolic pressure is normally 45-6 mm/Hg.

e. The Numerical Rating Scale or Faces system is used to measure the level of pain.

14. Prior to taking an oral, rectal, or axillary temperature, shake the thermometer so fluid level falls below
___________________F.

15. List the four contraindications to taking a patients oral temperature.

a. __________________________________________________________________________________

b. __________________________________________________________________________________

c. __________________________________________________________________________________

d. __________________________________________________________________________________

16. A rectal thermometer must be held in place ________ minutes in order to obtain an accurate rectal
temperature.

17. A lubricated rectal thermometer is inserted approximately _________ inches into the rectum of an adult.
159
Lesson 1.21 Vital Signs Worksheet Basic Hospital Corps School
Handbook 1

18. The two contraindications to taking a rectal temperature, are ______________________ and
___________________________.

19. In order to obtain an accurate axillary temperature, leave the thermometer in place _________________
minutes.

20. The ______________________ pulse is located on the thumb side of the wrist.

21. The brachial pulse is located ___________________________________.

22. The ______________________ pulse is located on the side of the neck.

23. The patient's pulse is counted for sixty seconds when:

a. __________________________________________________________________________________

b. __________________________________________________________________________________

c. __________________________________________________________________________________

24. The sound of normal respirations is __________________________.

25. Abnormal breath sounds are __________________________ or ___________________________.

26. When the blood pressure cuff is deflated, the gauge should register _________________________.

27. When taking a blood pressure with a stethoscope, the point at which the first sound is heard is called the
_________________________.

28. When taking a blood pressure with a stethoscope, the last sound heard is called the
___________________.

29. When not in use, the electronic thermometer read-out unit is stored in the ____________________.

30. Electronic sensing probes are color coded blue, for oral or axillary and ________________________
for rectal temperatures.

31. When not in use, the electronic unit used to take blood pressure and pulse should be
__________________________________ to recharge it.

160
Handbook 1 The Eye and Ear
Lesson 1.12

The Eye and Ear

Terminal Objective:

1.12 List the structures of the eye and ear and explain their basic functions.


1.12.01 List and identify the structures of the eye and their functions.

1.12.02 Define terms related to the process of vision.

1.12.03 List and identify the structures of the ear and their functions.

The eye is a specialized structure for the
reception of light. Accessory structures such as
the ocular muscles, eyelids, conjunctiva, and
lacrimal apparatus support its function.

Structures of the eye

The eyeball is a globe which consists of
various tissues that perform specific functions. Of
its total surfaces, only the anterior one-sixth is
exposed with the remainder protected by the orbit
into which it fits. It is composed of three layers,
Figure 1.12.01.

The white of the eye is called the sclera
(SKLIR-a). It is the outer coat of dense
connective tissue that gives shape to the eyeball
and protects the inner parts. It covers all of the
outer eye except the small area that is located
anteriorly, called the cornea (KOR-ne-a). The
cornea is a nonvascular, transparent, fibrous coat
that covers the colored iris. Because it is curved,
it admits and refracts light which helps the
eyeball to focus light.

The iris is a circular, pigmented muscular
structure, shaped like a flattened donut that gives
color to the eye. It is suspended between the
cornea and the lens. The hole or opening in the
center of the iris is called the pupil. The amount
of light entering the posterior cavity of the eyeball
through the pupil is regulated by the constriction
of radial and circular muscles in the iris. When
bright light is flashed into the eye, circular
muscular fibers of the iris contract, reducing the
size of the pupil (constriction). If the light is dim,
the radial muscles of the iris contract, increasing
the pupil's size (dilation). The size and reactions
of the pupils of the eyes are an important
diagnostic tool.

The lens is a transparent, nonvascular,
biconvex structure directly behind the iris and
pupil that helps with focusing of light rays for
clear vision. It separates the interior eye into
anterior and posterior cavities. The anterior cavity
contains a watery solution called aqueous humor
which helps maintain the shape of the cornea and
supplies oxygen and nutrients to the lens and
cornea. It is completely replaced about every 90
minutes. The posterior cavity is filled with the
vitreous humor which is a transparent, jelly-like
substance that helps prevent the eyeball from
collapsing and holds the retina flush against the
internal portions of the eyeball. It is formed
during embryonic life and cannot be replaced.

161
The Eye and Ear Handbook 1
The anterior portion of the second layer of the
eyeball is called the ciliary (SIL-e-ar'-e) body.
The ciliary body consists of two parts; the ciliary
process which secretes aqueous humor, and the
ciliary muscle which is a circular band of smooth
muscle that alters the shape of the lens for near or
far vision.

The innermost layer of the eye is the retina,
which receives images formed by the lens. It
contains different layers of nerve cells and blood
vessels, continuous with the optic nerve that
carries visual impulses to the brain. The retina is a
light sensitive structure on which light rays focus.
Rods are specialized nerve structures that respond
to low intensity light and are responsible for black
and white vision in dim light. Cones are also
specialized nerve structures but they respond to
higher light intensity and are responsible for color
vision, and high visual acuity (sharpness of
vision) in bright light. Cones are most densely
concentrated in the central fovea, a small
depression in the center of the posterior portion of
the retina. It is the area of sharpest vision because
of the high density of cones and the absence of
rods. Rods increase in number towards the
periphery of the retina. That is why you can see
better at night when not looking directly at an
object.

The optic nerve enters the back of the globe
and carries visual impulses received by the rods
and cones to the brain. The area where the optic
nerve enters the eyeball contains no rods or cones
and is called the blind spot. Normally, you are not
aware of the blind spot.

VISION PROCESS

Refraction is the deflection or bending of
light rays that occurs when light passes through
transparent substances of varying densities (such
as moving through the air and into the different
substances of the eye). As light rays enter the eye,
they are refracted at the anterior and posterior
surfaces of the cornea. Both surfaces of the lens
of the eye further refract the light rays so they
come into exact focus on the retina.

Accommodation is the process performed by
the lens that increases its curvature to refract light
rays into focus for near vision. The lens of the eye
is convex on both sides. Its focusing power
increases as its curvature becomes greater. When
the eye is focusing on a close object, the lens
curves more to bend the rays towards the central
fovea. When you view a close object, the ciliary
muscle contracts, which releases tension on the
lens. Since it is elastic, the lens shortens, thickens,
and bulges. Now that it is more rounded, its
focusing power is greater and the light rays
converge more.

Constriction of the pupil means narrowing
the diameter of the hole or opening through which
light enters the posterior cavity of the eye. It is
part of the accommodation mechanism which
consists of the contraction of the muscles of the
iris to constrict the pupils. This visceral reflex
occurs simultaneously with accommodation of the
lens and prevents light rays from entering the eye
through the periphery of the lens resulting in
blurred vision.

Convergence refers to the medial movement
of the two eyeballs so they are both directed
toward the object being viewed. Our eyes focus
on only one set of objects, giving us singular
binocular vision. When we stare straight ahead at
a distant object, the incoming light rays are aimed
directly at both pupils and are refracted to
comparable spots on the retinas of both eyes. As
we move closer to the object, our eyes must rotate
medially (converge) for the light rays from the
object to strike the same points on both retinas.
The nearer the object, the greater the degree of
convergence needed to maintain a single
binocular vision.

Inversion occurs because the light rays
passing through the lens cross each other and
appear on the retina in reversed position. The
result is an inverted image. The end-receptors
located at the rods and cones are stimulated by
light impulses which travel to the optic nerve and
on the occipital lobes of the brain. The reason we
do not see an inverted world is that the brain
learns early in life to coordinate visual images
with the exact locations of objects. The brain
stores memories of reaching and touching objects
and automatically turns visual images right side
up, Figure 1.12.02.
164

HEARING

The ear holds receptors for both sound waves
and equilibrium (balance). Anatomically, the ear
is divided into three parts: the external (outer) ear,
the middle ear, and the internal (inner ear.

External Ear

The external, or outer ear, is composed of
three parts, the auricle, external auditory canal,
and the tympanic membrane. Its function is to
collect sound from the environment.

The auricle (also known as the pinna) is a
cartilaginous structure shaped like the flared end
of a trumpet, located on each side of the head.
The auricle collects sound waves from the
environment and passes them inward.

The external auditory canal (also called the
meatus) is a curved tube that lies in the temporal
bone and carries sound waves from the auricle to
the tympanic membrane. Near the external
opening, it contains hairs and glands that secrete
cerumen (ear wax). The combination of hair and
cerumen helps prevent dust and foreign objects
from entering the ear.

The tympanic membrane (also known as the
eardrum) is a thin membrane that stretches across
the interior end of the external auditory canal and
separates the external ear from the middle ear.
The sound waves cause the tympanic membrane
to vibrate, transferring the sound waves from the
external environment to the auditory ossicles of
the middle ear, Figure 1.12.03.

Middle Ear

The middle ear (also called the tympanic
cavity) is a small, air-filled cavity in the temporal
bone that is lined with epithelium and contains
the three auditory ossicles and the auditory tube.

The auditory ossicles are bones named for
their shapes: the malleus (hammer), the incus
(anvil), and the stapes (stirrup). The handle of the
malleus is attached to the internal surface of the
tympanic membrane. Its head articulates with the
body of the incus. The incus is the intermediate
bone in the series and articulates with the head of
the stapes. The base or footplate of the stapes fits
into a membrane--covered opening in the thin,
bony partition between the middle ear and the
internal ear. This opening is called the oval
window.

The auditory tube (also called the
Eustachian tube) has an opening in the anterior
wall of the middle ear which connects it with the
nasopharynx (upper portion) of the throat. The
function of this tube is to equalize air pressure on
both sides of the tympanic membrane to ensure
that it vibrates freely when struck by sound
waves. Infections also may travel along this
pathway from the throat and nose to the ear. The
auditory tube is usually closed at its medial end;
during swallowing and yawning, it opens. This
allows atmospheric air from the throat to enter
and leave the middle ear until the internal
pressure equals the external pressure.

Internal (Inner) Ear

The internal (inner) ear is also called the
labyrinth (LAB-i-rinth) because of its
complicated series of canals. It contains the
cochlea and the semicircular canals. The canals
are lined with epithelium and contain a fluid
similar to intracellular fluid called endolymph,
which ripples from vibrations caused by the
auditory ossicles against the membrane over the
oval window. These ripples move to the cochlea.

The cochlea is a bony, spiral canal that
resembles a snail's shape that houses the spiral
organ (organ of Corti), also known as the organ of
hearing. It converts the mechanical ripples of the
endolymph into nerve impulses by stimulating
hair cells in the spiral organ which are receptors
for auditory sensations. These are relayed via the
cochlea to the cranial nerve and on to the auditory
area of the cortex in the temporal lobe of the brain
to be interpreted as sound.

The semicircular canals are three bony half-
circle canals situated perpendicularly to each
other in the temporal bone. Movement of
endolymph within the canals, caused by general
body movements, flows over hairs which then

163

bend to stimulate the nerve endings. This reports
changes in body positioning to the brain so that it
may take appropriate action to maintain
equilibrium, Figure 1.12.03.

FIGURE 1.12.01
THE EYE
164


FIGURE 1.12.02
THE VISION PROCESS
165

FIGURE 1.12.03
THE EAR

166

Handbook 1 The Eye and Ear Worksheet
Lesson 1.12

The Eye and Ear
Worksheet

1. Label the diagram of the eye.

2. Identify the eye structure that performs the following functions.

a. Allows light to enter the eye and is regulated by the iris ___________________________________

b The outer transparent layer that permits light to enter the eye. _______________________________

c. The tough, fibrous, protective layer of the eye. ___________________________________________

d. Contains nerve cells that are continuous with the optic nerve. _______________________________

e. A watery solution in front of the lens. __________________________________________________

f. Circular, pigmented muscular structure that gives color to the eye. ___________________________

g. A jelly-like fluid located behind the lens. _______________________________________________
167

The Eye and Ear Worksheet Handbook 1

3. Define refraction.
_______________________________________________________________________________________

_______________________________________________________________________________________

4. Define accommodation.
_______________________________________________________________________________________

_______________________________________________________________________________________

5. Describe convergence.
_______________________________________________________________________________________

_______________________________________________________________________________________

6. Label the diagram of the ear below.

168
Handbook 1 The Eye and Ear Worksheet
7. Identify the ear structure that performs the following functions.

a. Collect sound from the environment. __________________________________________________

b. Transport sound to the auditory ossicles. _______________________________________________

c. Convert the mechanical ripples of endolymph into nerve impulses. __________________________

d. Report the body's position so that equilibrium can be maintained. ____________________________

169

The Eye and Ear Worksheet Handbook 1
NOTES/COMMENTS

170
Basic Hospital Corps School Lesson 1.05 The Law of Armed Conflict
Handbook I

Lesson 1.05

The Law of Armed Conflict

Terminal Objective:

1.05 Apply the Law of Armed Conflict, in wartime scenarios to determine the appropriate actions to be
taken by a Hospital Corpsman.

Enabling Objectives

1.05.01 State the purpose of the Law of Armed Conflict.

1.05.02 State the principles of the Law of Armed Conflict as they apply to medical personnel and facilities.

1.05.03 State how the Law of Armed Conflict applies to prisoners of war, sick and wounded personnel,
civilians, and captured medical department personnel.

1.05.04 List the principles of the Law of Armed Conflict that apply to medical vehicles, aircraft and ships
.
1.05.05 Determine the appropriate action to be taken by a Hospital Corpsman in a wartime scenario, by
applying the Law of Armed Conflict.

Law of Armed Conflict

History tells of times of emergency when
military personnel went to war to defend their
nations' interests. Conflict has been frequent, and
often ruthless. As man became more civil, a
global decision was made by representatives from
65 nations (the United Nations) to settle
international disputes by peaceful means. Nations
were asked to stop using force to settle territorial
disputes.

There remain times when war is declared
between nations. In times of war, nations are
asked to abide by certain laws and international
rules.

The use of force by combatants of war is
regulated by the LAW OF ARMED CONFLICT.
The Law of Armed Conflict (LOAC) was created
by treaties during the Geneva Conventions. The
two major sources of the Law of Armed Conflict
are international customs and international
agreements.

Purpose

The purpose of the Law of Armed Conflict is
to ensure that during times of war, the violence of
hostilities is directed towards the enemy's military
forces. It also directs that hostilities are not used
to cause unnecessary suffering and destruction of
lives and property. It is intended to prevent
unnecessary escalation of warfare that may hinder
the return of peace.

General principals of the Law of Armed
Conflict are found in the rules governing military
forces.

The principal rule deals with humane
treatment. It has three concepts:

1) Civilians and noncombatants will be
protected. Enemies will also be protected if they
are captured or detained, because of their
171
Lesson 1.05 The Law of Armed Conflict Basic Hospital Corps School
Handbook 1
fundamental rights as human beings. These
fundamental rights are retained, regardless of
their beliefs prior to capture.

2) Military forces and their governments that
comply with the rules are reflecting the moral
values that civilized man practices in a society. So
it is forbidden to use dishonorable means to
concentrate violence. It is also forbidden to use
conduct that is treacherous during armed conflict.
Examples of these means and treacherous conduct
will be discussed later in the chapter, under
medical personnel and facilities.

3) Violations of the Law of Armed Conflict
are considered the same as breaking the law of the
nation. Since the United States takes a leadership
position in adopting these rules for its military
forces, a violation of this international law is also
a violation of our own federal law. The Law of
Armed Conflict is an international law that has
been accepted by the United States.

Law and order are necessary even in war.
Although combat is different from everyday life,
common sense and humane treatment in combat
will help in many ways. Following the Law of
Armed Conflict will increase a unit's discipline
and its security. Law, order and humane treatment
of all captured or detained noncombatants and
combatants wins support at high levels, and helps
to win battles and restore peace. The nations of
the world use the Law of Armed Conflict to
prevent unnecessary escalation of warfare that
may hinder restoration of peace.

Violations of the Law of Armed Conflict
serve to cause bad effects in different ways.
Disobedience or neglect of the Law of Armed
Conflict detracts from, and in some cases,
prevents mission accomplishment. Members
violating the rules bring dishonor upon
themselves, their military branch of service, and
their nation. Violations usually strengthen the
enemy's will rather than weaken it. Violations of
the Law of Armed Conflict are punishable in the
United States Armed Forces under the Uniform
Code of Military J ustice (UCMJ ).

Medical Department Personnel

The purpose of medical personnel serving in
war is primarily humanitarian. Medics and
corpsmen are considered noncombatants. In 1949,
the Geneva Conventions provided that those
personnel exclusively engaged in the specific
activity of saving lives should be respected and
protected in all circumstances. Medical personnel
are placed under this protective umbrella because
the activities they perform are all related to
humanitarian services. Some wartime functions
medical personnel perform include: a) search,
collection, transport, and treatment of the sick or
wounded; b) prevention of disease; and c)
administrative support to medical units and
facilities.

Protective Signs and Emblems

So that medical personnel continue to receive
protection from hostile enemy action, they are
obligated (and have the right) to wear the medical
service emblem on their left arm. The emblem is
affixed to the uniform by a water resistant band.
Medical personnel should display the distinctive
emblem when engaged in their respective medical
activities. The Red Cross on a white background
is an internationally accepted symbol of medical
personnel and activities. The armed forces of the
United States use the RED CROSS.

Moslem countries use a red crescent on a
white field. Israel uses the red Star of David. Iran
uses the Lion and the Sun emblem.

Medical personnel are also obligated to carry
a special Geneva Convention Card (DD 1934)
bearing the emblem of the Red Cross. This is for
the use in the identification of individuals
responsible for carrying out medical functions.
Personnel who lose their identification items are
provided with replacements.

Use of Weapons

Self-defense (including protection for the
wounded and sick), is the only legitimate use of
weapons by medical department personnel. They
may carry semi- automatic weapons solely to
protect themselves against wrongful attack.
Medical personnel may also carry weapons while
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Handbook 1

serving as sentries or guards while protecting a
hospital. During this duty, they retain their
protected status.
Medics or corpsmen may not use weapons
against enemy forces that are acting in accordance
with the Law of Armed Conflict. Medical
personnel may protect themselves against
wrongful attack.
Illegal use of weapons by medical personnel
can result in the loss of the special protection
from hostile enemy action granted to medics.
With the loss of this protection, personnel may be
subjected to lawful retaliation. The loss may also
result in medical personnel becoming prisoners of
war (POW's). The POW status may result in
assigned duties that are incompatible with
medical service.

Medical Department Facilities and
Equipment

Medical facilities and equipment are to be
used solely for the care of the sick and wounded.
The 1949 Geneva Convention provided that
facilities and equipment used exclusively for the
care of the sick and wounded should be respected
and protected in all circumstances.

Medical facilities and equipment must be
marked with an appropriate medical service
emblem. (Red Cross for the U. S.) It is a serious
violation of the Law of Armed Conflict for non-
medical personnel to use the medical service
emblem to protect or hide military activities.

Hospitals and other medical activities can
lose their special status if they commit acts
harmful to the enemy outside their prescribed
functions.

According to the Geneva Conventions,
medical establishments (facilities) and units,
mobile and fixed-medical vehicles, and medical
equipment and stores may not be deliberately
bombarded. Allies and enemy forces are required
to ensure all medical facilities and units are
readily identifiable (marked with an appropriate
service emblem, the Red Cross, etc.). The medical
facilities should also be geographically situated so
as to avoid attacks directed against military
targets.

If medical facilities are used for purposes
inconsistent with their humanitarian and medical
mission, they become subject to attack. These acts
include the following: a) acting as an observation
point, b) acting as a shelter for able-bodied
combatants, c) serving as the location for
communication equipment used for relaying
operational information, and d) serving as a
storage site for arms, ammunition, or other non-
medical supplies.

Medical Ships, Vehicles and Aircraft

Hospital ships are marked as follows: the
exterior surfaces shall be white, except for the
areas designated for the identifying medical
insignia. Three Red Crosses shall be painted on
each side of the hull; forward, center, and aft.
Hospital ships are not classified as war ships.
Therefore, hospital ships can leave port even if
the port falls into enemy hands.

Medical evacuation aircraft are protected
from capture if engaged exclusively in
transporting sick and wounded. They are also
protected when transporting medical personnel
and equipment. The aircraft, however, must be
flying at approved altitudes, times, and routes.
Medical aircraft must obey a summons to land,
and can be searched. For medical purposes, the
aircraft shall be allowed to continue on its flight.

Medical ground vehicles and supplies fall into
a category of their own. Contrasted to the hospital
ships and evacuation aircraft, these vehicles and
their supplies are considered Proper Objects of
Capture by the enemy forces. They must be
reserved for the care of the sick and wounded. All
vehicles specifically used for the transport of the
sick and injured must be marked with large Red
Crosses on a white background. The medical
service emblem provides easy identification for
medical mission vehicles.

POWs, Sick or wounded POWs,
Civilians, Captured Medical Personnel

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According to the Geneva Convention,
wounded and sick personnel falling into enemy
hands must be treated humanely at all times. The
physical and mental well-being of enemy
wounded and sick personnel may not be
endangered. No medical procedures can be
performed unless they are warranted by the
medical condition of the patient.
Prisoners of War (POW) are defined as
combatants no longer subject to attack because
they have individually laid down their weapons to
surrender, are no longer capable of resistance, or
because the unit in which they are serving has
surrendered or been captured. Combatants
entitled to POW status must be treated humanely.
They must be protected against violence,
intimidation, torture, insult, and public curiosity.

POW's are given medical treatment equitably,
regardless of race, nationality, creed, gender, or
other criteria. Considerations for treatment will be
based primarily upon medical conditions.

Medical considerations for POW's are similar
to the considerations of allied personnel. Medical
personnel must provide treatment for injuries and
attempt to prevent the spread of disease.

In addition, the following considerations
should be addressed for POW's: a) prisoners must
be provided adequate housing, ensuring
cleanliness and a healthy environment, b)
prisoners must be provided food rations and
drinking water, c) prisoners must be inspected on
a monthly basis.

Monthly medical inspections by medical
personnel should assess the general health,
nutritional status, and the actual or potential
presence of any contagious diseases. If during the
medical assessment it is determined that the
health or physical condition of any POW seem to
have gravely diminished, those individuals will be
repatriated (returned to their homeland) provided
they are fit to travel.

POWs to be repatriated generally fall into one
of three categories: a) an incurable disease or
condition, b) a POW who is permanently
disabled, or c) a POW who is unlikely to recover
from their condition (illness) within a year and
requires treatment for the disease or condition.

It is the primary responsibility of all medical
personnel to ensure that sick and wounded POW's
receive medical care and human treatment. Care
is given as required by their condition, to the
fullest extent possible. Medics and corpsmen are
to ensure that every effort is made to prevent any
delay in treatment. Treatment is given without
regard to status as friend or foe. POW's should be
evacuated from combat areas as soon as possible.

Civilians

The civilian population as well as individual
civilians shall not be the object of attack, threats
or acts intended to instill terror (Geneva
Conventions 1949). Civilian populations include:
all persons not serving in the armed forces,
militia, or paramilitary forces, as well as persons
not otherwise taking a direct part in the hostilities.
Traditionally included as civilians are women and
children.

According to the law of armed conflict,
civilians are entitled to humane treatment.
Women and children are entitled to receive
special respect and protection. Violations of the
law of armed conflict inflicted upon civilian
populations would include inhumane treatment,
such as: torture, rape, pillage, and unnecessary
destruction of property. It is also a violation to
steal or burn property.

The law of armed conflict requires that
civilians be respected according to their native
people, their honor, their family rights, their
religious beliefs, and their customs. Civilians may
not be held hostage, nor exposed to unnecessary
danger. Civilians may, however, be required to
move or be resettled for military reasons, e.g.,
clearing a combat zone, to ensure their safety.

Captive Medical Personnel

Captured medical personnel do not become
prisoners of war. They may, however, be detained
by the enemy to provide for the medical needs of
prisoners of war. Medical personnel must be
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repatriated (returned to their own side) at the
earliest opportunity. Medical personnel are not
authorized to accept official assignments to the
medical service of the enemy's armed forces.
Medical personnel are not authorized the duty to
escape or to aid others in escaping as a POW.
They are not authorized to assume command of
other POW's.

Conclusion

The purpose of the Law of Armed Conflict is
to prevent an escalation of war that prevents rapid
and efficient return to more peaceful times.
International law exists to prevent the direction of
violence and hostilities toward noncombatants
(civilians, POW's, sick POW's, and medical
personnel). The Law of Armed Conflict is
intended to prevent the unnecessary loss of lives
and property.

The purpose of medical personnel, their
facilities, and their presence in wartime situations
is primarily humanitarian. Medical personnel treat
the sick and wounded. Medical ships and aircraft
are provided by military forces in times of war to
treat and evacuate noncombatants away from
locations close to combat.

Medical personnel must remember that in
conforming with the Law of Armed Conflict, all
persons are entitled to humane treatment,
regardless of their political beliefs or conduct
prior to capture. Every medical department
member is obligated to obey the Law of Armed
Conflict.

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NOTES/COMMENTS

176
Basic Hospital Corps School Lesson 1.05 Law of Armed Conflict

Lesson 1.05

Law of Armed Conflict Worksheet

1. The Law of Armed Conflict recognizes:

a. captured enemies have no rights.

b. war is always immoral.

c. the moral values of civilized society.

2. Disobedience of the Law of Armed Conflict may result in:

a. military service members who honor their nation, their service, and themselves.

b. strengthening of the enemies' will.

c. rewards under the UCMJ .

d. easy mission accomplishment.

3. Under the Law of Armed Conflict, Medical Department personnel are considered:

a. nonpersons.

b. nonexistent.

c. nonproductive.

d. noncombatants.

4. Medical personnel assigned to combat units are obligated and have a right to:

a.__________________________________

b.__________________________________

c.__________________________________

5. The only legitimate use of weapons by medical personnel is defense of self and patients.

a. True b. False

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Lesson 1.05 Law of Armed Conflict Basic Hospital Corps School
6. Illegal use of weapons by medical personnel can result in:

a. ____________________________________________

b. ____________________________________________

c. ____________________________________________

7. Medical facilities and equipment are to be use solely for the care of the sick and injured.

a. True b. False

8. Hospitals can lose their special, protected status if they are used to commit acts harmful to the enemy such
as:

a. serving as an observation post.

b. treatment facility for US combatants.

c. treatment facility for enemy combatants.

d. storage for medical supplies.

9. Prisoners of War:

a. have no rights.

b. may be tortured if they try to escape.

c. must be provided with medical care.

d. receive food and water only from the Red Cross.

10. Captured medical personnel are prisoners of war

a. True b. False

11. Captured medical personnel are authorized to:

a. provide medical treatment to prisoners of war.

b. assume command of POW's.

c. aid others in escaping.

d. provide medical treatment to members of the enemies' armed forces.

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Basic Hospital Corps School Lesson 1.05 Law of Armed Conflict

12. How are Hospital ships different than warships?

a.__________________________________________________

b.__________________________________________________

c.__________________________________________________

13. Medical vehicles and supplies:

a. must be destroyed.

b. are proper objects of capture.

c. if captured, may be used for any purpose.

d. are camouflaged to protect the sick and wounded.

14. Match the appropriate choice from column B with each situation in column A. Answers in column B
may be used more than once.

A B

a. A hospital ship transporting combat troops.

__________

b. A corpsman kills an enemy who fired at him first.

__________

c. A doctor assumes command of POWs.

__________

d. A hospital is used to store ammunition.

__________

e. Medical vehicles and supplies are captured.

__________

f. A corpsman leads an escape from a POW camp.

__________

1. Not allowed by the Law of Armed Conflict

2. Allowed under the Law of Armed Conflict.

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Lesson 1.05 Law of Armed Conflict Basic Hospital Corps School
NOTES/COMMENTS

180
Basic Hospital Corps School Lesson 1.06 Basic Medical Ethics
Handbook I
Lesson 1.06

Basic Medical Ethics
Terminal Objective:

1.06 List implications of medical, legal and ethical issues as they relate to the Hospital Corpsman.


1.06.01 Define terms associated with medical ethics.

1.06.02 List factors which affect ethical decisions.

1.06.03 State types of medical-ethical problems.

1.06.04 List reactions that patients and family members may exhibit when confronted with
trauma and illness.

1.06.05 List emotional reactions that the Hospital Corpsman may experience when responding to
trauma and illness.

1.06.06 List patient rights in the American Hospital Association (AHA) Bill of Rights.

1.06.07 State the ethical behavior required by the Hospital Corpsman's Pledge.

The term ETHICS comes from the Greek
word ethos, meaning customs or modes of
conduct. Ethics may be described as a system
of moral or philosophical principles dealing
with what is right or wrong. The origin of the
word ethics refers to that which is customary
or habitual with certain groups of people.
Webster defines ethics as a principle of right
or good behavior. Ethical is similar to the
word moral, which means the good thing to
do. Ethics also refers to the rules or standards
of conduct governing the members of a
profession such as lawyers, accountants,
bankers, ministers, physicians, nurses, and
corpsmen. Standards of conduct help to
distinguish the moral goodness or badness of
human actions.

Bioethics - ethics as applied to life (and
death) decision making.

Medical ethics is commonly defined as those
moral standards of conduct that are
traditionally accepted by professional
medical organizations.

A code of ethics is a list of written
statements describing ideal behavior for
members of a particular group. A code of
ethics defines professional practice.

Many organizations representing health
care professionals have developed ethical
codes. Examples of health oriented
organizations that have codes (standards):

1. American Medical Association -
Principles of Medical Ethics.

2. American Nurses Association - Code for
Nurses.

3. American Hospital Association - A
Patient's Bill of Rights.

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Lesson 1.06 Basic Medical Ethics Basic Hospital Corps School
Handbook I
4. The National Association of Emergency
Medical Technicians - The EMT Code of
Ethics.

5. Hospital Corps, USN - Hospital
Corpsman's Pledge.

Ethical codes of conduct would not be
needed if existing laws in society covered
every circumstance in which persons find
themselves.

Rights - something a person is entitled
to, a legitimate expectation.

Law - rules made by humans that
regulate social conduct in a formally
prescribed and legally binding manner.

Ethical principles have their foundation
in three basic areas of law.

Civil laws - those that the government of
a county, state, or country established - are
enacted by the people for the people. They
are designed for the welfare and protection of
the majority and generally reflect the will or
morals of that society. Some civil laws that
impact medical care are:

1. Confinement of the mentally insane for
the protection and welfare of society as
well as for the protection and treatment
of the insane.

2. Required reporting of communicable
disease to prevent their spread and to
further research.

3. Licensing requirements for Health Care
Providers to provide standards of
education and training for those who care
for the sick and injured.

Moral laws - those laws rooted in
religious or cultural traditions - are based on
good triumphing over evil and are dictated by
our conscience (our sense of right and
wrong). From the time we are small children,
we are influenced by our parents, families,
teachers, cultural traditions, heritage, and
religious training as to what is good or bad.
Moral actions should be directed toward the
achievement of a good/positive affect and not
toward an evil/negative affect. Religious or
cultural traditions have taboos that can affect
medical practices. Some examples of these
effects on patients are:

1. J ehovahs Witnesses may view blood
transfusions as morally wrong and refuse
to accept a blood transfusion. It is their
belief that blood is life and, therefore, it
is wrong to take the life out of another.

2. Roman Catholics view abortion as
morally wrong and may refuse to
participate when they are performed
because it is their belief that a life is
being taken.

Natural laws (physical laws) are the
basic laws of nature that control the universe
and all that exists in it, e.g., the law of gravity
or the laws of physics. Examples of natural
laws dealing with the process of life and
death include: the issue of brain death versus
clinical death, cardiopulmonary resuscitation,
and genetic engineering (manipulation of
genes/DNA to produce altered organisms).

Civil, moral, and natural laws and their
intertwined relationships allow us to examine
and deal with the final determination as to
what is ethical.

Values - freely chosen, enduring beliefs
or attitudes about the worth of a person,
object, idea or action.

Value System - the organization of a
persons values along a continuum of relative
importance.

Morals (morality) - personal standards of
right and wrong.
Advocate one who pleads the case of
another.
Privileged Communication
information given to a professional
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Handbook I
person who is forbidden by law from
disclosing the information in a court
without the consent of the person who
provided it.
Informed Consent an agreement by a
client to accept a course of treatment or a
procedure after complete information,
including the risks of treatment and facts
relating to it, have been provided by the
physician.
Expressed Consent Consent given by
adults who are of legal age and mentally
competent to make a rational decision in
regard to their medical well-being.
Implied Consent it is presumed that a
patient, or patients parent or guardian,
would give consent if they could.

Medical Ethical Issues Currently
Debated

ALLOCATION OF RESOURCES. With
the decreasing amount of dollars Congress
appropriates for the Department of Defense
for the provision of health care, not all
military personnel will be cared for in a
military medical treatment facility. The
population of dependents and retirees are
particularly vulnerable to health care reform
in the military. More frequently, they are
disengaged from the active duty military
medical treatment facility and transferred to a
civilian health care institution.

WITHHOLDING OR WITHDRAWING
TREATMENT. Sometimes health care
practitioners are called upon to make a
decision of treating a patient or not treating a
patient during the course of hospitalization.
Sometimes the responsibility of deciding
whether to stop treating must be made for a
patient. No one person can make these
decisions easily, or justly without considering
other alternatives. Often, decisions are given
over to a team of medical ethicists for the
purpose of deciding what is best for a patient.

PROTECTING PATIENT'S RIGHTS
(see table 1.6.01). As mentioned earlier, a
group of individuals may be responsible for
deciding what is best for a patient rather than
placing all responsibility upon one
individual. Our jobs can increase our anxiety
and frustration when we must help patients
and their families deal with difficult
decisions. Protecting a patient's rights can be
very difficult when there is no a clear answer
to the question of what is right.

MAKING ETHICAL DECISIONS. Is
this the right decision for what is best for my
patient? Is this the wrong decision for the
well-being of my patient? This problem that
my patient is experiencing does not seem to
be very clear, nor does there seem to be any
easy answer. What is right? What is wrong?
These questions are asked often by health
care providers when trying to decide upon a
course of action concerning a patient's future.

Some medical ethicists believe that
decisions should be made with a strong sense
of justice in mind. Other ethicists believe that
decisions should be made with an even
stronger sense of responsibility in mind. And,
others believe that both justice and
responsibility can be used hand-in-hand to
assist in decision-making. J ustice or rights-
based approaches to making decisions is
known as doing what is right or best for the
patient. Responsibility-based decisions rest
on an understanding that give rise to
compassion and care.

As a health care provider, you are
expected to be grounded in medical ethical
knowledge and application. This is necessary
to assist and care for patients and their
families, especially when dealing with
stressful situations. The emotional stages of
dealing with death, trauma and long-term
illness are: Denial, Anger, Bargaining,
Depression and Acceptance. As a Hospital
Corpsman, you or your peers may experience
emotional reactions as a result of responding
to these situations. Emotional reactions vary
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Handbook I
in degree according to the individual and
his/her ability to reduce or alleviate stress.

AMERICAN HOSPITAL ASSOCIATION
PATIENT BILL OF RIGHTS

The relationship between the patient and
the nurse is characterized as a partnership
that encourages the active participation of
both patient and nurse, in identifying,
planning and resolving health problems.
This partnership mandates certain rights and
responsibilities for the patient and health care
provider. These rights have legal and ethical
implications. The American Hospital
Association Patient Bill of Rights is widely
distributed to patients and posted in health
care facilities. Violation of these rights can
lead to legal actions. Nurses can ensure
violations are avoided by being the patient's
advocate. These rights are as follows:

1. Right to be informed - patients have
the right to complete and current information
concerning their diagnosis, treatment, and
prognosis. This information is to be provided
in language that is understandable to the
patient. Patients have the right to know about
the risks and or benefits of care and treatment
recommended. Additionally they have the
right to be told of alternatives that may be
used in their care and treatment. Patients also
have the right to know what rules and
regulations apply to their conduct.
Compliance ensures that the patient will be
able to make an informed choice.

2. Right to Choose - patients have the
right to refuse treatment, to the extent
permitted by law, and to be informed of the
medical consequences of their choices. A
patient cannot be forced to stay in a hospital
or medical treatment facility; to hold a patient
is false imprisonment. An adult patient who
is competent may leave even if the health
care providers believe he/she should remain
for additional care. Under these conditions,
the patient is provided a release form to sign
that indicates that he/she is leaving of his/her
own free will and against medical advice.
Mentally ill patients and some patients with
certain communicable diseases may be
legally detained in a medical treatment
facility against their will if it can be shown
that they are a danger to society.

3. Right to be Heard and Respected -
patients have the right to privacy; everyone
has the right to withhold himself from public
exposure. Failure to cover patients, pull
privacy curtains, or close doors to rooms may
violate privacy laws and could result in
lawsuits. Patients have the right to expect
that all communication and records
pertaining to their care be treated as
confidential. Maintaining patient
confidentiality is critical to the nurse-patient
relationship. Health care providers are not to
discuss information about patients with
anyone who is not involved in the patient's
care. Talking about patients with classmates,
co-workers, and others is an unwise, illegal
and unethical practice. Maintaining a
patient's privacy and listening to what they
have to say is how we treat patients with
dignity. Ensuring others treat patients with
dignity is also a way to be a patient advocate.

4. Right to Safety - patients have a right
to products that have been tested and found
to be safe. They have the right to care from
providers who have met the qualifications for
safe practice. Care providers who require
licenses must keep those licenses current.
Providers are required to seek and obtain
training and certification in the most current
clinical practices to provide optimal care to
patients.

PATIENT EXPECTATIONS OF
MEDICAL CARE PROVIDERS

1. Be current and knowledgeable in the
practice of nursing.

2. Be competent in the performance of
nursing skills.

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Handbook I
3. Be committed to providing patient
services.

4. Be available when needed.

5. Ensure privacy.

6. Be courteous and accepting of
differences among individuals.

7. Allow patient participation in
decision-making.

8. To provide explanations in terms and
language that is understandable.

9. To listen to and believe what is said.

10. To teach improvement of health
techniques that will promote
improvement of heath.

THE PLEDGE

On graduation day you will take the
Hospital Corpsman's Pledge. A pledge is
defined by Webster as a formal promise to do
or not to do something. The Hospital
Corpsman's Pledge is the medical code of
conduct for members of the Hospital Corps
and is a solemn promise made to God, fellow
corpsmen and future patients. This pledge
defines behavior as right or wrong. The ethics
for Hospital Corpsmen are derived from the
pledge.

Hospital Corpsman's Pledge

I solemnly pledge myself before God
and these witnesses to practice faithfully all
of my duties as a member of the Hospital
Corps. I hold the care of the sick and
injured to be a privilege and a sacred trust
and will assist the Medical Officer with
loyalty and honesty. I will not knowingly
permit harm to come to any patient. I will
not partake nor administer any
unauthorized medication. I will hold all
personal matters pertaining to the private
lives of patients in strict confidence. I
dedicate my heart, mind and strength to the
work before me. I shall do all within my
power to show in myself an example of all
that is honorable and good throughout my
Naval career.

Your CODE OF ETHICS is to:

Hold the care of the sick and injured to
be a privilege and a sacred trust

Traditionally, medical personnel have
been looked upon as special by society. In
our society, doctors have been elevated to a
position of trust and respect because they
have the power to heal. In the last 100 years,
other medical professionals have been raised
to similar positions of respect. Even the
Geneva Convention has a special section that
pertains to medical personnel granting them a
privileged status. Though not all of us
actually heal the sick and injured, we do play
a role in their recovery. No duty is too menial
if it contributes to the health and well-being
of the patient. This privileged status carries
with it an obligation. We have been tasked by
society to care for them. We must NOT take
this responsibility lightly, but with humility
and grace and as a special duty to our fellow
man. Do not judge patients by what they say,
do, or believe, but provide patients with the
utmost respect for human dignity and
individualism.

Serve with loyalty and honesty

Be reliable and dependable in the
performance of your duties. Be respectful of
those you work for and with. We must be
trustworthy. Our supervisors and peers must
know that they can depend on us to do our
job and care for our patients. We must be
able to admit if we omit a procedure or
perform it wrong so any problems can be
corrected if at all possible. There is no room
in our profession for cover-ups. The patient's
life is more important than our ego.

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Handbook I
Never knowingly permit harm to come
to any patient

Patients trust us to take care of them.
Physical harm can occur by improperly
performed or documented procedures. Doing
any procedure incorrectly, at the improper
time, or that we are not specifically trained to
do, can harm the patient. Emotional harm can
occur by failing to work with your patients
properly. Not respecting the patient's value
system may bring emotional harm to him/her
because it destroys the corpsman - patient
relationship that we work hard to build. A
person's values are his/her own. Although we
do not have to accept a patient's values, we
must be courteous and tolerant of them.
Know your limitations, do NOT render care
that you are not trained to perform.

Do not take nor administer any
unauthorized medication

Patients deserve 100% of your attention
and skills to make decisions and care for
them. We violate the trust of our patients and
break down the corpsman - patient
relationship when we allow our judgment to
be affected and our reasoning to be altered.
The physician will prescribe patient
medication. J unior corpsmen typically do not
possess the authority or knowledge to initiate
medications; however, Corpsmen who have
been specifically trained and designated in
writing by their Commanding Officer may
prescribe in the absence of a Medical Officer.
Health care providers should not take
unauthorized medications because their side
effects will affect the ability to provide safe
patient care.

Hold in strict confidence all personal
matters pertaining to patient private lives

Patients are likely to share things that
they might not share with a minister. Respect
the trust the patient has in you. Do NOT
discuss information with anyone not involved
in the care of the patient (you may talk with
the legal guardian of a child). We are morally
and legally bound to keep these matters
private and not engage in gossip
conversations about patients in the elevator,
chow hall, or office. Do NOT judge patients
by what they say, do or believe. Care for
them all! They simply feel the need to tell
someone what they have done or been
involved in. In order to preserve the
corpsman - patient relationship, you must
exert great restraint at times to keep these
feelings to yourself and not let them show.
Sometimes facts might be assumed from the
patient's diagnosis. Don't make too many
assumptions! These assumptions may or may
not be correct, and even if they are correct,
we are not in a position to judge someone
else's life as being right or wrong. We may
destroy not only the corpsman - patient
relationship we have built with this patient,
but future professional relationships this
patient may have with our peers.

Dedicate heart, mind, and strength to
the duties of the hospital corps

Working in the medical profession is not
merely a job. Our responsibilities are great
regardless of our training, job description, or
rate/rank. Our job is not an easy profession, it
requires 100% effort. It is more of a calling
than a job. Not everyone is cut out for our
line of work. Further, not everyone can work
in the medical environment for a lifetime,
often due to the stresses involved. It is our
responsibility to maintain competency in
skills: consistently strive to improve and
increase our knowledge. This can be
accomplished through on-the-job training, in
service training, correspondence courses, or
continuing education. It is important that we
be willing and able to give everything to our
mission: Caring for the sick and the injured.
Our patients depend on us.

At all times show an example of all that
is honorable and good

Your conduct, on and off duty, is to be
beyond reproach. The world watches us.
They have expectations of our behavior both
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Handbook I
on and off duty. Our culture and our customs
have granted us a special status among our
fellows. It is important that patients have trust
and confidence in us, for it makes our job of
caring for them easier. Respect the sacrifices
of those who have worn the caduceus before
you; do nothing to disgrace it.

We will be faced with issues that
sometimes go against our personal beliefs of
what is right or wrong. It will involve the
actions, attitudes or beliefs of patients or it
may involve the actions, attitudes or beliefs
of co-workers, seniors, or subordinates. There
will also be times when we question our own
value system. We must control the urge to
enlighten others on our own beliefs about
issues.

The Hospital Corps is the ONLY enlisted
Corps and is noted for:

1. Gallantry and Courage.

2. Unswerving dedication to our country,
shipmates, and patients.

These are now your ethics. J udge
yourself by them. You are now responsible to
uphold them. They should guide your
behavior.

AREAS OF ETHICAL CONCERN

You may not deal with complex ethical
topics on a daily basis, but ethical behavior is
the foundation for clinical practice.

Be aware of your beliefs and feelings as
they relate to such issues as abortion, the
right to die, euthanasia, and human
experimentation because they could impact
your interactions with patients.

Areas of ethical concern that daily affect
Corpsmen include:

PATIENT EDUCATION AND
COMPLIANCE
All procedures and treatments should be
explained to the patient in simple, clear, and
thorough terms. This is done out of respect
for the individual as a person who has a right
to know and in order to elicit cooperation
from the patient for his/her own welfare.
Do this with every procedure, even the
simple ones.

CONFIDENTIALITY

Our patients trust us with privileged
information and depend on our loyalty and
devotion to them to keep that information
private. Written documents have civil laws to
protect the confidentiality of personal
information about a patient. As our pledge
states, Never permit harm to come to any
patient. This includes emotional harm,
which would occur as a result of
indiscriminate talk to others in public areas.
Discuss patient information ONLY with
members of the patient's health care team.
Patient information can be released to
guardian/NOK in special situations, e.g.,
pediatrics, incompetent patient, SL/VSL.
Discussing a patient with another member of
the patient's family, without the patient's
consent, could be a violation of this principle.
Do NOT discuss the private matters of a
patient in public, e.g., elevator talk. This is
considered gossip.

PATIENT PRIVACY

Patient privacy encompasses the idea that
we care for our patients as we ourselves want
to be treated. Respect each patient's privacy
by avoiding unnecessary exposure of the
patient; pull the curtain for privacy - even
when the room only has one patient - and to
expose only that part of the patient that must
be exposed to complete the procedure.
Always offer a stand-by (a person of the
same gender as the patient) during any
physical exam: male for males and females
for females. Respect the patient's privacy by
knocking on the door of the patient's room or
simply asking, May I come in? when the
187
Handbook I
curtains are drawn. Maintain the dignity of
each patient.

PROFESSIONAL BEHAVIOR

It is our military and professional
responsibility to uphold the highest standards
of care entrusted to us. We must continue to
learn and improve our skills. We portray
professional behavior every day in our
grooming standards and in our interactions
with patients, their families, and friends.
Loyalty to an oath includes reporting
incompetent individuals or any unethical
practice that is witnessed (this is a military
duty to report per UCMJ ).

PATIENT RIGHTS

The American Hospital Association has
developed a list of patient rights. The Patient
Bill of Rights is posted in every ward and
treatment area, Figure 1.06.01. It lists guiding
principles that every patient can expect in the
care they receive, e.g., the patient has the
right to considerate and respectful care and
the patient has the right to expect reasonable
continuity of care.

Ethical concepts of health care include
principles Incorporated in the Hospital Corps
Pledge
As a corpsman, you cannot perform your
duties adequately if you get caught up in
battling the value systems of others. The
Pledge of the Hospital Corps and the ethical
duties contained in it do not indicate that
corpsmen are to judge patients or seek to
change a patients value system. Nor are you
to perform procedures just because you think
you should be allowed to or blatantly lead a
life-style that could bring discredit to the
Corps as a whole. It is customary for
members of the Hospital Corps to accept
others as they are and to respect each person
as an individual.

FREEDOM OF CHOICE. In order to
choose freely between receiving care and not
receiving care, a person has the right to know
what the care involves. He or she also has the
right to know the risks involved, and the
duration of the care. Once the patient has
been informed of all these facts, the patient
then may agree to proceed without coercion
or interference from the health care
practitioners. This is known as informed
consent.

DOING NO HARM. If the patient gives
the health care practitioners permission to
carry out a plan of care, the patient should be
assured that all attempts will be made to
prevent harm. Without the permission or
informed consent of the patient, any bodily
contact by a member of the medical team
may be perceived as an attempt to cause
bodily harm.

TELLING THE TRUTH. When caring
for our patients we have an obligation to be
honest about all matters concerning their
health. A typical ethical issue that arises often
involves patients who are terminally ill. The
unresolved conflict relates to whether or not
the patient should be told what he is facing,
and who should tell the patient. Building a
basis of trust with the patient may be helpful
when dealing with difficult issues.
Determining what is best for the patient is
sometimes challenging and can cause
frustrating consequences.

DO GOOD. Our job as corpsmen and
health care practitioners is to do good. We
must ensure care for all. Doing good is caring
for others. As we responsibly take care of
others, we stand with them, not against them.
We participate with others in providing care,
we do not resist them. We seek to help others
find care and we also seek to direct that care.
We are responsible.

FAIRNESS. At the core of fairness is a
central concept that is older than America;
yet American in the true sense of the word.
J ustice is a concept that holds a particular
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Handbook I
importance in our society and in the
provision of health care. J ustice helps to
establish an equality among individuals
living with one another. J ustice helps to make
legitimate the desires of people, and it brings
fairness to those desires.

FAITHFULNESS OR PROMISE-
KEEPING. Our faithfulness and being an
advocate is not always is an easy job. Many
times things get in our way of being faithful
or keeping promises with our patients. We all
must follow the orders of the patients
physician, but when we question decisions
that are made for our patients, we often end
up feeling frustrated or even angry. As
technology increases the difficult job of
caring for our patients, we are faced with
large obstacles. Being the patients advocate
and being faithful to the needs of our patients
is becoming very challenging.

189
Handbook I
America Hospital Association
Bill of Rights

Right Definition
The patient has the right to considerate and respectful
care.

The patient has the right to obtain from the physical
complete current information concerning diagnosis,
treatment, and prognosis
When it is not medically advisable to give such
information to the patient, it should be given to a
person in the patients behalf.
The patient has the right to receive from the physician
information necessary to give informed consent prior
to the start of any procedure or treatment
Except in emergencies, informed consent should
include but not limit to procedure, treatment, risk,
and duration of the problem
The patient has the right to refuse treatment to the
extent permitted by law
Active duty may require further consideration of
treatment against the will.
The patient has the right to every consideration of
privacy concerning his own medical care program.
The patient must give permission to others to be
present that are not directly involved in his care.
The patient has the right to expect that all
communications and records pertaining to the care
should be confidential.
This is to protect the right of privacy.
The patient has the right to expect that within its
capacity a hospital must make reasonable response to
the request of a patient for services.
The hospital must provide evaluation, service, and
referral as indicated by the urgency of the case.
The patient has the right to obtain information as to
any relationship of the hospital to other health care
institutions.
The patient has the right to obtain information as to
the existence of any professional relationships
between individuals.
The patient has the right to be advised if the hospital
proposes to engage in human experimentation
affecting his care or treatment.
The patient has the right to refuse to participate in
such research projects.
The patient has the right to expect reasonable
continuity of care.
He has the right to know in advance what
appointment times and physicians are available.
The patient has the right to examine and receive an
explanation of the bill.

The patient has the right to know what hospital rules
and regulations apply to his conduct as a patient.

Figure 1.06.01

190

Lesson 1.06

Basic Medical Ethics Worksheet

1. Match the correct definition in column B with each term in column A.

A B

a. Ethics ______

b. Medical Ethics ______

c. Code of Ethics ______

d. Rights ______

e. Civil Laws ______

f. Moral Laws ______

g. Natural Laws ______

1. Laws rooted in religious or cultural traditions.

2. Something a person is entitled to, a legitimate expectation

3. Those laws that are established by a government.

4. A system of moral or philosophical principles that
identifies actions as right or wring.

5. Basic laws of nature that control the universe.

6. A list of ideal behavior statements which defines
professional practice for a particular group

7. Moral standards of conduct that are traditionally accepted
by professional medical organizations.

2. Hospital Corpsmen pledge to hold in strict confidence all personal matters pertaining to patients private
lives. Which of the following violates the Hospital Corps Pledge?

a. Respect the trust your patient has in you.

b. Discuss with your friends interesting patient information

c. Discuss patient information with other direct caregivers

d. Have a nonjudgmental attitude toward your patients

3. List three ways that harm can come to a patient.

a. _____________________________________________

b. _____________________________________________

c. _____________________________________________
191

4. Mark the following statements T (true) or F (false) as they apply to the Hospital Corpsmen's Pledge.

_____a. It is a promise made to a higher power.

_____b. Ethics for Hospital corpsmen are derived from this pledge.

_____c. It is a legal document that is signed as a contract.

_____d. It defines behavior as right or wrong.

_____e. You will take another pledge as you advance in rank.

_____f. It allows you to prescribe medication.

_____g. Your conduct, on and off duty, is to be beyond reproach.

5. Patients deserve your attention and skill. Choose the percent required to dedicate your heart, mind, and
strength to the duties of the Hospital Corps.

a. 25%

b. 50%

c. 75%

d. 100%

6. List three areas of ethical concern that affect Hospital Corpsmen.

a. _______________________________________________

b. _______________________________________________

c. _______________________________________________

7. Private matters of a patient may be discussed in:

a. elevators.

b. clinical conferences.

c. the mess hall.

d. the passageway.

192

8. List four ethical concepts common to health care.

a.__________________________________________________

b.__________________________________________________

c.__________________________________________________

d.__________________________________________________

9. List three current issues in health care.

a.__________________________________________________

b.__________________________________________________

c.__________________________________________________

10. List the four patient rights in the AHA Bill of Rights.

a.__________________________________________________

b.__________________________________________________

c.__________________________________________________

d.__________________________________________________

11. What reactions may be exhibited when people are confronted with trauma, illness or death?

a.__________________________________________________

b.__________________________________________________

c.__________________________________________________

d.__________________________________________________

e.__________________________________________________

193
12. List four emotional reactions HMs may experience when responding to trauma and illness.

a.__________________________________________________

b.__________________________________________________

c.__________________________________________________

d.__________________________________________________

13. List three methods to reduce or alleviate stress related to involvement with trauma and illness.

a.__________________________________________________

b.__________________________________________________

c.__________________________________________________
194
Handbook 1 The Genitourinary System
Lesson 1.17

The Genitourinary System

Terminal Objective:

1.17 List the structures of the genitourinary system (reproductive and urinary systems) and their basic
functions.


1.17.01 List and identify the structures of the male reproductive system and describe their functions.

1.17.02 List and identify the structures of the female reproductive system and their functions.

1.17.03 List the steps in the menstrual cycle.

1.17.04 List and identify the structures of the urinary system and their functions.

1.17.05 List the basic steps in the formation of urine.

1.17.06 List the basic characteristics of urine.

The genitourinary system is composed of
two related systems: the reproductive system and
the urinary system. The suffix genito refers to
the reproductive system. Urinary system refers to
the organs that filter the blood, producing wastes
in the form of urine and excrete it. Since some
organs are common to both systems, the two
systems are often referred to as the genitourinary
system.

THE MALE REPRODUCTIVE
SYSTEM

The penis, Figure 1.17.01 and Figure 1.17.02,
is composed of three cylindrical rods or columns
of erectile tissue. The glans penis is the bulging
structure at the distal end that forms the head of
the penis. The penis function is to ejaculate semen
into the external environment.

The urethra is a tube that leads from the
urinary bladder to outside the body. In the male, it
functions in both the urinary and reproductive
systems, discharging urine and sperm.

The scrotum is a skin-covered pouch of
contractile tissue suspended from the perineal
region. The function of the scrotum is to keep the
testes at an optimum temperature for sperm
production. Internally, it is divided into two sacs,
each containing a testis, epididymis, and the first
portion of the vas deferens.

The testes are the male gonads, and are
essential organs of reproduction. There is one
testis located in each scrotal cavity. Within the
testes are coiled tubes and interstitial cells. Sperm
production occurs here. The interstitial cells
secrete the male hormone, testosterone which
promotes maleness, and development and
maintenance of secondary sex characteristics.

195
The Genitourinary System Handbook 1
The vas deferens serves as a connecting tube
between the epididymis and the ejaculatory duct.
It transmits sperm to the ejaculatory duct. The
epididymis is a coiled tube which provides
storage and transportation of sperm.

The ejaculatory duct is formed at the union
of the vas deferens and ducts of the seminal
vesicles. It terminates in the urethra at the prostate
gland. The primary function is transportation of
secretion. The seminal vesicles are convoluted
pouches lying along the inferior and posterior
bladder and secrete viscous alkaline fluid. This
fluid provides a nutrient-rich medium for sperm.

The adrenal glands are located on the
superior surface of each kidney and produce the
sex hormone androgen.

The prostate gland is a doughnut shaped
gland about the size of a walnut that encircles the
urethra, just inferior to the bladder. During
ejaculation, it secretes a thin milky, acidic fluid
which carries the spermatozoa and provides
nourishment. It is palpated during a rectal exam to
check for cancer.

THE FEMALE REPRODUCTIVE
SYSTEM

The female reproductive system is
predominantly an internal system. In this section,
the basic structures will be discussed, Figure
1.17.03.

The Ovaries (female gonads), Figure 1.17.04,
are two almond-shaped glands located on each
side of the uterus. Immature ova (eggs) are stored
in the ovaries. During the menstrual cycle, the
ovum matures in one of the ovaries and is
released into the fallopian tubes. The ovaries also
belong to the endocrine system. This function is
to produce estrogen and progesterone. These are
hormones that stimulate sexual desire, and
maintain the lining of the uterus for implantation.

The fallopian tubes serve as ducts, providing
a passageway through which the ova are
transported to the uterus. from the ovaries. The
sperm fertilizes the ovum in the fallopian tube.

The uterus is a structure in the pelvic cavity
that functions in labor, menstruation and
pregnancy. The walls of the uterus are composed
of three layers. The inner layer, or endometrium,
sloughs off every 28 days if pregnancy does not
occur. If pregnancy occurs, these layers provide
nourishment to the fetus. The uterus is pear-
shaped, about 3 inches long and 2 inches across.
The uterus has three main subdivisions: fundus,
body, and cervix. The fundus is the portion
located above the fallopian tubes. The body is
located between the cervix and the fundus. The
cervix is the lower portion that opens into the
upper vagina.

The vagina, Figure 1.17.05, is a
musculomembranous, collapsible tube that is
capable of great distention. It is situated between
the rectum and urethra. The vagina has three main
functions: accommodating the penis during
intercourse, channeling menstrual blood from the
uterus, and serving as the birth canal during
childbirth.

The vulva constitutes the female external
genitalia and includes the mons pubis, labia
majora, labia minora and clitoris. The mons pubis
is a rounded cushion of fatty and connective
tissue covered by skin and coarse curly hair. The
labia, or lips, form the prominent cutaneous outer
and inner folds of the vaginal opening. The
clitoris is the small, protuberance located just
beneath the arch of the mons pubis The perineum
is the muscular region located between the
vaginal orifice and the anus.

An accessory organ to the female
reproductive system is the mammary glands.
These glands develop at puberty under the
influence of estrogen and progesterone. The
function of these glands is the production of milk
for nourishment of the newborn.

The adrenal glands are located on the
superior surface of each kidney and assist in
producing such hormones as androgen, estrogen,
progesterone, steroids, and chemicals such as
adrenalin (epinephrine).

196
MENSTRUAL CYCLE
a. Help regulate the composition and volume of
blood
b. Help regulate blood pressure
The menstrual cycle is part of the complex
reproductive system and is regulated by
hormones. Menses is the sloughing of the
endometrium, or uterine lining. After menses, an
immature egg starts maturing in one of the two
ovaries. This process is stimulated by a hormone.
c. Contribute to metabolism

The outer layer of the kidneys is the cortex,
which is reddish-brown in color, Figure 1.17.08.
The medulla is the inner, spongy layer that
contains a mass of tubules that drain urine into the
renal pelvis. The primary functional unit of the
kidney where the work takes place is the
nephron, Figure 1.17.09. Each kidney contains
more than a million nephrons. The renal
corpuscle is where the blood is filtered. The
renal tubule is the portion of the nephron where
substances needed by the body are reabsorbed.
The renal pelvis collects the urine and forms the
ureter as it narrows and exits the kidney.

Ovulation or the release of the mature egg by
an ovary occurs approximately every 28 days.
The left and right ovaries alternate in maturing
and expelling an ovum (egg). Ovulation occurs
approximately mid-cycle or 12 to 15 days after
the first day of the previous menses.

The time between the last day of menses and
the next ovulation is called the preovulatory
period. During this time, the hormone estrogen
causes the uterus to prepare a new surface layer
and the cervix to increase secretions of mucous.

The ureters are tubes which carry urine from
each kidney to the bladder by peristalsis. The
bladder is a hollow, muscular organ in the pelvic
cavity which collects urine before elimination
from the body. The urethra is a small tube
leading from the bladder to the outside of the
body. It is the terminal portion of the urinary
system.

The postovulatory phase is the time between
ovulation and the onset of the next menses.
During this time, the mature egg continues to
enlarge and secretes a hormone called
progesterone. If the egg is not fertilized, the
hormone production stops, the egg size decreases,
and menses occurs.

Urine is the excreted fluid that results from
the kidney's filtration of blood in a two part
process. Filtration is the process in which arterial
pressure forces plasma through the nephron
where water, salts, glucose, and other dissolved
blood components are filtered out of the blood.
The filtration process is not very selective. A lot
of material is filtered out of the blood. Selective
reabsorption allows glucose, water, and essential
proteins to return back into the blood stream.
About 99% of the filtrate is returned to the blood.
The remaining 1% of filtrate is waste products
which are excreted as urine

THE URINARY SYSTEM

The primary function of the urinary system,
Figure 1.17.06 and Figure 1.17.07, is to help
maintain homeostasis by controlling the
composition, volume and pressure of the blood. It
does so by removing and restoring selected
amounts of water and solutes. The urinary system
is composed of two kidneys, two ureters, one
urinary bladder, and a urethra.

The kidneys, Figure 1.17.07, are located just
above the waist between the parietal peritoneum
and the posterior wall of the abdomen, below the
diaphragm. They are protected by the lower ribs.
They filter the blood, removing the waste
products of metabolism, then selectively reabsorb
some of the products such as water. The kidneys
have three primary functions:
The average adult excretes 1 to 2 liters of
urine every 24 hours. Urine is normally yellow or
amber colored, but the color varies with the
individual's diet and the concentration of the
urine. Urine is normally slightly acidic. It has an
aromatic odor, but becomes ammonia like if left
standing. Urine is about 95% water and 5% waste
products.
197

FIGURE 1.17.01
MALE REPRODUCTIVE SYSTEM

FIGURE 1.17.02
MALE REPRODUCTIVE SYSTEM
198

FIGURE 1.17.03
FEMALE REPRODUCTIVE SYSTEM

FIGURE 1.17.04
OVARIES

199

FIGURE 1.17.05
FEMALE GENITALIA

FIGURE 1.17.06
UNIRARY SYSTEM IN FEMALE AND MALE
200

FIGURE 1.17.07
URINARY SYSTEM
Longitudinal section through the hilus
of a kidney

1 Renal capusle 5 Renal Artery
2 Cortex 6 Renal vein
3 Medulla 7 Renal Pelvis
3a Pyramid 8 Ureter
3b Papilla
4 Calyx
FIGURE 1.17.08
PARTS OF THE KIDNEY
201

FIGURE 1.17.09
NEPHRON

NOTES/COMMENTS

202
Lesson 1.17

The Genitourinary System
Worksheet

1. What ejaculates semen into the environment?

a. Prostate

b. Ejaculatory duct

c. Seminal vesicles

d. Penis

2. What is the name of the tube that functions for both urinary and reproductive system, to carry urine and
sperm to the outside of the body?

a. Testes

b. Urethra

c. Ejaculatory duct

d. Seminal vesicles

3. Sperm production occurs in the:

a. testes.

b. prostate.

c. vas deferens.

d. seminal vesicles.

203
The Genitourinary System Worksheet Handbook 1

4. Describe the functions of the ovaries.

_____________________________________________________________________________________

_____________________________________________________________________________________

5. Describe the function of the uterus.

_____________________________________________________________________________________

_____________________________________________________________________________________

6. What structure produces estrogen and progesterone?

a. Ovaries

b. Uterus

c. Vagina

d. Vulva

7. What structure has three main sub-divisions named the fundus, body and cervix?

a. Ovaries

b. Uterus

c. Vagina

d. Vulva

8. The release of a mature ovum into the fallopian tube is called ___________________________________.

9. Filtering the waste products of metabolism from the blood is the basic function of the:

a. bladder.

b. testes.

c. urethra.

d. kidneys.

10. What is the basic functional unit of the kidney where filtration takes place?

204
a. Bladder

b. Nephron

c. Testes

d. Ureter

11. The layers of the kidney are called the cortex and:

a. medulla.

b. renal body.

c. testes.

d. urethra.

12. The small hollow muscular organ which stores urine until discharge is the:

a. bladder.

b. testes.

c. urethra.

d. kidney.

13. The tube which carries urine from a kidney to the bladder is called the:

a. renal tubule.

b. ureter.

c. urethra.

d. nephron.

14. Humans excrete about ____________________ liters of urine every 24 hours.

15. Normal urine is clear, amber, or _________________________ colored.

205
Basic Hospital Corps School Lesson 1.02 Basic Mathematics
Handbook 1

Lesson 1.02

Basic Mathematics

Terminal Objective:

1.02 Solve basic mathematic problems.


1.02.01 Define terms related to common fractions.

1.02.02 State the fundamental rules of fractions.

1.02.03 State the addition and subtraction operations of like and unlike fractions.

1.02.04 State the multiplication operations of fractions.

1.02.05 State the division operation of fractions.

1.02.06 Define terms related to reading and writing of decimal numbers.

1.02.07 State the addition and subtraction operation of decimals.

1.02.08 State the multiplication operation of decimals.

1.02.09 State the division operation of decimals.

1.02.10 State the operation of converting a decimal to a fraction.

1.02.11 State the operation of converting a fraction to a decimal.

1.02.12 State the operation of converting a decimal to a percent.

1.02.13 Define the operation of ratios.

1.02.14 State the use of ratios in the medical field.

1.02.15 Define weight and measurement abbreviations in the metric and US liquid systems.

1.02.16 Convert weights and measures between the metric and the US liquid measurement system.

207
Lesson 1.02 Basic Mathematics Basic Hospital Corps School
Handbook 1
SOLVE FRACTIONAL NUMBER
ADDITION, SUBTRACTION,
MULTIPLICATION AND DIVISION
PROBLEM

In math, it often happens that we must operate
with fractions. In order to understand clearly how
to perform the operations, let us recall some of the
facts about fractions in arithmetic.

From arithmetic we know that a common
fraction consists of two numbers, one written
above the other, with a horizontal line between
them: thus 3/4. The number above the line is called
the numerator. The number below the line is called
the denominator. The numerator and the
denominator are called the terms of a fraction. The
numerator represents how many parts of the whole
number are being considered and the denominator
represents how many equal parts the whole is
being divided into.

TYPES OF FRACTIONS: Fractions are often
classified as proper or improper. A proper fraction
is one in which the numerator is numerically
smaller than the denominator. An improper
fraction has a numerator that is equal to or larger
than its denominator.

Mixed numbers, when the denominator of an
improper fraction is divided into its numerator, a
remainder is produced along with the quotient,
unless the numerator happens to be an exact
multiple of the denominator. For example: 7/5 is
equal to 1 plus a remainder of 2. This remainder
may be shown as a dividend with 5 as its divisor,
as follows:

7/5 =5+2/5 =1 +2/5

The expression 1 2/5 is a MIXED NUMBER.

FUNDAMENTAL PRINCIPLES

Before we consider the different operations
with fractions, it is important that we thoroughly
understand the following principle: When
multiplying or dividing both terms of a fraction by
the same number does not change the value of the
fraction. A fraction multiplied by 1 does not
change the value of the fraction.1 can be expressed
as a fraction where the terms are the same number.
Such as: 3/3, 7/7, 29/29, or 1/1.

Example of multiplying by 1:

4/5 x 1/1 =4/5 4/5 x 7/7 =28/35 28/35=4/5

REDUCING FRACTIONS: A fraction is said
to be reduced to lowest terms when the numerator
and the denominator have been made as small as
possible by dividing each by some factor found in
both.

To reduce fractions to lowest terms, we make
use of the fundamental principle by dividing the
numerator and denominator by some common
factor. In some fractions we can tell at a glance
what number is a divisor of both numerator and
denominator. A factor is any number that evenly
divides into a given whole number, (evenly =no
remainder).

Reduction to lowest terms is accomplished by
finding the greatest common factor (GCF) of both
the numerator and the denominator and dividing
both by it. To find the GCF of the numerator and
denominator you must determine all the factors of
each and then select the largest common term.

Divide the numerator and the denominator by
the largest common term and the result will be a
fraction reduced to lowest terms. A fraction is
stated in its lowest terms when the numerator and
denominator do not contain a common factor or
when 1 is the only number that divides evenly into
both the numerator and the denominator. If the
greatest common factor cannot be easily
determined (usually by inspection), the fraction
may be divided by any common factor repeatedly
until the fraction is in its lowest terms.

LIKE AND UNLIKE FRACTIONS: Fractions
with the same denominator are called like
fractions. Like fractions are added and subtracted
by performing the function on the numerator only.
Pounds can be added to pounds, and pints to pints,
but not ounces to pints. Eighths can be added to
eights, and fourths to fourths, but not eighths to
fourths. To add 1/5 inch to 2/5 inch we simply add
the numerators and retain the denominator
208
Handbook 1

unchanged. The denomination is fifths; as with
denominate numbers, we add 1 fifth to 2 fifths to
get 3 fifths, or 3/5.

Similarly we can subtract like fractions by
subtracting the numerators and place it over the
same (unchanged) denominator.

When the denominators of fractions are
unequal, the fractions are said to be unlike.
Addition, subtraction, or division cannot be
performed directly on unlike fractions. The proper
application of the fundamental rule, however, can
change their form so that they become like
fractions; then all the rules for like fractions apply.

LOWEST COMMON DENOMINATOR: To
change unlike fractions to like fractions, it is
necessary to find a Common Denominator and it is
usually advantageous to find the LOWEST
COMMON DENOMINATOR (LCD). This is
nothing more than the least common multiple of
the denominators. The lowest common factor of a
set of numbers can be determined in two ways: 1)
Identify the multiples of each number and then
select the lowest common multiple between the
numbers. 2) Determine the prime factors of each
number and multiply them appropriately. Use each
factor the most number of times it occurs in both
of the numbers. Multiply these factors and the
result is the LOWEST COMMON FACTOR
(LCF).
Example
28 =2 x 2 x 7_____
48 2 x 2 x 2 x 2 x 3

The prime number 2 occurs in both the numerator
and the denominator twice. Multiplying these
common prime factors, 2 x 2 = 4, so the LOWEST
COMMON FACTOR is 4.

Use the LCF to change unlike fractions to like
fractions (fractions with the same denominators).
Then solve as like fractions.

To subtract unlike fractions, repeat the
preceding steps. Then solve as like fractions.

MULTIPLICATION

To find the product of two or more fractions
multiply their numerators together and write the
result as the numerator of the product; multiply
their denominators and write the result as the
denominator of the product; reduce the answer to
lowest terms. In using this rule with mixed
numbers, rewrite all mixed numbers as improper
fractions before applying the rule.

Cancellation is a short cut that can be used
when multiplying fractions. It is similar to
reducing, the basic principle is to multiply or
divide both the numerator and the denominator by
the same number. This does not change the value
of a fraction.

DIVISION

There are two methods commonly used for
performing division with fractions. One is the
common denominator method and the other is the
reciprocal method.

Common Denominator Method - Change the
dividend and divisor to like fractions and divide
the numerator of the dividend by the numerator of
the divisor.

Reciprocal Method - The word reciprocal
denotes an interchangeable relationship. It is used
in mathematics to describe a specific relationship
between to numbers. We say that two numbers are
reciprocals of each other if their product is one. In
the example 4 X 1/4 =1, the fractions 4/1 and 1/4
are reciprocals. Thus obtain the reciprocal of the
divisor (invert the divisor). Multiply the dividend
by the reciprocal of the divisor. A mixed fraction
must be converted into an improper fraction in
order to be manipulated in a division problem.
Always convert the answer into a proper fraction.
Cancellation can be utilized during multiplication
steps.

SOLVE DECIMAL NUMBER
ADDITION, SUBTRACTION,
MULTIPLICATION,
AND DIVISION PROBLEMS

A decimal fraction is a fractions whose
denominator is 10 or some power of 10, such as
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Handbook 1
100, 1,000, or 10,000. Decimal fractions have
special characteristics that make computation
much simpler than with other fractions. In the
study of whole numbers, we found that we could
proceed to the left from the units place, tens,
hundreds, thousands, and on indefinitely to any
larger place value, but the development stopped
with the units place.

Each digit in a decimal has a place value and is
read a certain way. In the number 0.3 we say that 3
is in the first decimal place; in 0.03, 3 is in the
second decimal place; and in 0.003, 3 is in the
third decimal place. Thus:

0.3 =3 TENTHS

0.03 =3 HUNDREDTHS

0.003 =3 THOUSANDTHS

0.0003 =3 TEN THOUSANDTHS

0.00003 =3 HUNDRED THOUSANDTHS

The decimal - 0.362" - is read as three hundred
sixty two thousandths. When there is a whole
number and a decimal point, the decimal point is
read as and". The decimal 7.05 is read as seven
and five hundredths.

WRITING DECIMALS

Any decimal fraction may be written in the
shortened form by a simple mechanical process.
Simply begin at the right-hand digit of the
numerator and count off to the left as many places
as there are zeros in the denominator. Place the
decimal point to the left of the last digit counted.
The denominator may then be disregarded. If there
are not enough digits, as many place-holding zeros
as are necessary are added to the left of the left-
hand digit in the numerator. Thus, forty-five
thousands will require three digits because it is in
the thousandths place. It is written 0.045. Seven
and ninety-six hundredths is written, 7.96.

ADDITION

Adding decimals, tenths are written under
tenths, hundredths under hundredths, etc. When
this is done, the decimal points fall in a straight
line.

SUBTRACTION

Subtraction of decimals likewise involves no
new principles.

The place values of the subtrahend are directly
under the corresponding place values in the
minuend. Also the decimal point will be aligned
and the figures in the answer also retain the correct
columnar alignment. We subtract column by
column, as with whole numbers, beginning at the
right.

MULTIPLICATION

Decimals are multiplied just as whole
numbers, BUT decimal points must be placed into
the product. Place the number with more digits
placed over the number with fewer digits. 0.6489
times 1.10 should be written as:

0.6489
X 1.10

Multiply just as whole numbers.

0.6489
X1.10
00000
6489
6489
713790

Count the number of digits behind the decimal
point in both numbers. 0.6489 has 4 places to
the right of the decimal and 1.10 has 2 places to
the right of the decimal. The total of both is 6
digits that must be to the right to the decimal in the
answer, so count the number of places from the
right of the product and place the decimal point.
0.713790.

DIVISION

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Handbook 1

Division of decimals is similar to division of
whole numbers BUT the divisor must be expressed
as a whole number before division is started. This
is accomplished by moving the decimal in the
divisor all the way to the right. Then move the
decimal in the dividend the same number of places
to the right. Place the decimal in the quotient the
same number of places to the right. Then divide.

CONVERTING A DECIMAL TO A
FRACTION

Make the digits of the decimal the numerator
of a fraction. To convert 0.025 to a fraction, the 25
becomes the numerator. The denominator of the
fraction has a 1 followed by the same number of
zeros as there are digits in the decimal. The
denominator will be 1000. This represents its place
value and corresponds to a power of ten.

0.025 = 25
1000

Reduce to lowest terms: 25 =1
1000 40

There may be times when a whole number
accompanies a decimal. In that case follow the
same steps but place the whole number before the
fraction - changing the whole number and the
decimal into a mixed number.

To convert a fraction to a decimal, divide the
numerator by the denominator.

PERCENT(%)

Percent is the parts per hundred. The fraction
6/100 is the same as the decimal 0.06. The six
indicates 6 parts per hundred. 6% of a number
means 6/100 of it which again indicates 6 parts per
hundred. To change a decimal to percent, move the
decimal point two places to the right. Thus 0.028
becomes 2.8 and is therefore 2.8% .

To change a percent to a decimal drop the
percent sign and move the decimal point two
places to the left. 25.4% =0.254. A decimal point
is not shown with a whole number, (it is
understood). When changing a whole number
percent to a decimal move the understood decimal
two places to the left: 23(%) =0.23.

CALCULATE RATIOS AND
DETERMINE THE RELATIONSHIP
BETWEEN RATIOS

A ratio is a comparison of two like quantities.
It is the quotient obtained by dividing the first
number of a comparison by the second. Ratios are
written with ratio sign (a colon) between two
numbers. The ratio of 5 to 4 can be expressed as:

A. Ratio sign 5:4

B. Fraction 5/4

C. Division 5)4

D. Decimal notation 1.25

Comparison by ratio is limited to quantities of
the same measurable unit. For example, in order to
express the ratio between 6ft and 3yds, both
quantities must be written in terms of the same
unit. Thus the proper form of this ratio is 2yd :
3yd, not 6ft : 3yd. When the parts of the ratio are
expressed in terms of the same unit, the units
cancel each other and the ratio consists simply of
two numbers. In this example, the final form of the
ratio is 2 : 3.

Since a ratio is also a fraction, all the rules that
govern fractions may be used in working with
ratios. Thus, the terms may be reduced, increased,
simplified, and so forth, according to the rules for
fractions. To reduce the ratio 15 : 20 to lowest
terms, write the ratio as a fraction and then
proceed as for fractions. Thus, 15 : 20 becomes;

Hence the ratio of 15 to 20 is the same as the
ratio of 3 to 4.

INVERSE RATIO: Often times it is necessary
to compare numbers in a inverse (reverse) order.
This is done by simply interchanging the
numerator and the denominator. Thus, the inverse
211
Handbook 1
of 15:20 is 20:15. When the terms of a ratio are
interchanged, the INVERSE RATIO results.

PROPORTION

Closely allied with the study of ratio is the
subject of proportion. A proportion is nothing
more than an equation in which the members are
ratios. In other words when two ratios are set equal
to each other, a proportion is formed. The
proportion may be written.

15:20 = 3:4

All forms are read, 15 is to 20 as 3 is to 4. In
other words, 15 has the same ratio to 20 as 3 has to
4.

Each ratio may refer to the same or different
units of measurements. Ratios can be equal to,
greater than or less than, one another.

PRINCIPLE OF PROPORTION

A proportion is an equation expressing
equality between ratios.

A:b: =c:d or a =c, and b =d

The FIRST and LAST terms (outside terms) of
a set of ratios are known as the EXTREMES.
Example:
If a:b =c:d a and d are the extremes.
The SECOND and THIRD terms (inside
terms) of a set of ratios are known as the means.

Example:

If a:b =c:d b and c are the means.

In any proportion, the product of the means
equals the product of the extremes.

a:b =c:d (Extremes) ad =bc (means)

Use the principle of proportion to determine
the relationship between ratios. Set up the ratios in
the equation for proportion ad =bc. The product of
the means equals the product of the extremes.
Determine the relationship.

The relationship can also be determined by
working the ratios as fractions. Change ratios to
fractions. Convert fractions to decimals by
dividing the denominator into the numerator.
Compare the quotients to determine if the ratios
are: equivalent to; greater than; or less than; one
another.

The most common use of ratios in the medical
field is to identify the strength or concentration of
a solution. The first number in the ratio represents
the number of parts of a material (salt, iodine) that
is dissolved in a liquid. The second number in the
ratio represents the number of parts of the liquid
used (water, alcohol, etc) to dissolve the material.
Then compare the two ratios to determine which is
strongest:

A. When the liquid parts (SECOND number
in the ratio) are equal, the ratio with the largest
amount of dissolved material (FIRST number) is
the strongest or the most concentrated solution.
5:10 is stronger than 1:10, and 3:8 is stronger than
2:8

B. When the materials to be dissolved
(FIRST number) are equal, the solution with the
least liquid (SECOND NUMBER) is the strongest
or most concentrated. 6:40 is stronger than 6:55 or
3:10 is stronger than 3:100.

If none of the numbers in the ratio are the
same, the ratios must be compared to determine
their relationship to one another. Is the solution
7:25 stronger than 8:55?

Use the principle of proportion: the product of
the means equals the product of the extremes.
(7)(55) = 385 and (25)(8) = 200. 385>200
THEREFORE the 7:25 solution is stronger than
the 8:55 solution. Manipulate the ratios as
fractions: 7/25 =0.28, 8/55 =0.145. 0.28>0.145
THEREFORE the 7:25 solution is stronger than
the 8:55 solution.

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Handbook 1

DEFINE WEIGHT AND
MEASUREMENTS ABBREVIATIONS
IN THE METRIC AND US LIQUID
SYSTEMS.

METRIC - Systems of measurement based
upon the metric system.

Use decimals to express amounts less than 1.
Use whole numbers to express amounts of 1 or
greater. Never use fractions.

Abbreviations in the Metric System

1. Weight measurement.

A. Kilogram =Kg

B. Grams =Gm

C. Milligram =mg

D. Microgram =mcg

2. Fluid measurement.

A. Liter =L

B. Milliliter =ml

C. Cubic centimeter =cc

Abbreviations in US Liquid System

1. Drop =gtt

2. Teaspoon =tsp

3. Tablespoon =tbsp

4. Ounce =oz

CONVERT WEIGHT AND
MEASURES BETWEEN THE
METRIC SYSTEM AND THE US
LIQUID MEASUREMENT SYSTEM

At times it may be necessary to convert from
one measurement to another within a system, or
one system to another. A conversion table will list
what the equivalent amount are within a system
and between different systems. To convert
multiply what you have by the conversion factor.
The conversion factor is the number of units of
what you need, that equals one unit of what you
have. Or you may think in terms of what you have
and what you need.

Formula

What you HAVE times the CONVERSION
FACTOR is equal to what you NEED, measured
in the system you want.

To convert 30 gm to kg:

The unit gram is what you HAVE because its
value is given in the problem. The unit kilogram is
what you NEED because its value is what must be
determined. Consult the conversion chart to find
the number of kilograms that equal one gram. 1gm
= 0.001kg. Multiply what you HAVE by the
CONVERSION FACTOR

1. 30gm =what you have

2. 1 gm =0.001kg (Conversion Factor)

3. 30 x 0.001 =0.30

4. 30gm =0.030kg

To CONVERT 200ml TO L

Find the conversion factor ml to L. Multiply
what you have by the conversion factor.

1. 200 =what you have

2. 1ml =0.001 L (Conversion Factor)

3. 200 x 0.001 =0.2

4. 200ml =0.2L
213
Handbook 1

WEIGHTS AND MEASURES CONVERSION TABLE

METRIC WEIGHT MEASURE
1 Kilogram (Kg.) = 1000 grams (Gm.)
1 Gram (Gm.) = .001 kilograms (Kg.)
1 Gram = 1000 milligrams (mg.)
1 Milligram (mg.) = .001 gram (Gm.)
1 Milligram = 1000 Micrograms (mcg.)
1 Microgram (mcg.) = .001 Milligram (mg.)

METRIC FLUID MEASURE
1 Liter (L) = 1000 milliliters (ml)
1 Milliliter (ml) = .001 liter (L)
1 Milliliter (ml) = 1 cubic centimeter

US LIQUID MEASUREMENTS AND METRIC FLUID MEASURES
U.S. Liquid Metric
1 drop (gtt) = .06 milliliter (ml)
15 drops (gtts) = 1 milliliter (ml)
1 teaspoon (tsp) = 5 milliliters (ml)
1 tablespoon (Tbsp) = 15 milliliters (ml)
1 ounce (oz) = 30 milliliters (ml)
1 cup (c) = 240 milliliters (ml)
1 pint = 480 milliliters (ml)
1 quart = 960 milliliters (ml)
4 cups (c) = 960 milliliters (ml)

214

Lesson 1.02

Basic Mathematics Worksheet

1. Match each definition in column B to the correct term in column A.

A B

a. Fraction _____

b. Numerator _____

c. Denominator _____

d. Proper fraction _____

e. Improper fraction _____

f. Mixed numbers _____

1. The numerator is equal to or greater than the denominator.

2. A whole number and a proper fraction

3. An indicated division

4. The digit below the line.

5. The digit above the line.

6. The numerator is less than the denominator

2. Reducing fractions means to change the terms without changing _________________.

3. To reduce a fraction to lowest terms you must find the _________________________.

4. Perform addition and subtraction on the following fractions.

a. 2/70 + 6/7 ____________

b. 2/3 + 5 1/8 ____________

c. 5/16 + 18/24 ____________

d. 5/9 - 1/9 ____________

e. 5/6 - 1/3 ____________

f. 9 - 6 4/12 ____________

215

5. Perform multiplication on the following fractions.

a. 1/2 X 1/2 ____________

b. 4/9 X 3/8 X 1/9 ____________

c. 3/4 X 16/24 X 11/12 X 24/33 ____________

6. Perform division on the following fractions.

a. 2/3 / 1/3 ____________

b. 1/5 / 1/12 ____________

c. 3 4/9 / 1 2/7 ____________

7. A decimal is a number that represents a fraction without the denominator.

a. True b. False

8. Add or subtract the following decimals.

a. 0.15 + 0.79 ____________

b. 0.59 + 2.73 ____________

c. 5.82 + 0.54 ____________

d. 0.96 - 0.62 ____________

e. 3.75 - 1.37 ____________

f. 7.41 - 2.22 ____________

9. Multiply the following decimals.

a. 0.24 X 0.78 ____________

b. 0.61 X 1.97 ____________

c. 3.35 X 7.46 ____________

10. Divide the following decimals.

a. 0.96 / 0.32 ____________

b. 4.80 / 2.14 ____________

c. 0.75 / 3.00 ____________

216

11. Convert the following decimals to fractions.

a. 0.75 ____________

b. 0.64 ____________

c. 0.59 ____________

d. 3.21 ____________

12. Convert the following fractions to decimals.

a. 3/8 ____________

b. 7/9 ____________

c. 6/5 ____________

d. 18/4 ____________

13. Convert the following decimals to percents.

a. 0.75 ____________

b. 0.001 ____________

c. 0.04 ____________

d. 0.255 ____________

14. Match each definition in column B to the correct term in column A.

A B

a. Ratio _______

b. Inverse ration _______

c. Extremes _______

d. Means _______

e. Proportion _______

1. The second and third terms (inside terms) of a set of ratios.

2. An equation expressing equality between ratios.

3. A comparison of two likes qualities by division.

4. Compare numbers in a reverse order by interchange of terms.

5. The first and last terms (outside terms) of a set of ratios.

217

15. Ratios are used in medicine to identify the strength or concentration of a solution.

a. True b. False

16. The metric system uses:

a. fractions to express amounts less than 1.

b. decimals to express amounts less than 1.

c. mixed numbers .

d. household measurements.

17. What is the abbreviation for each of the following measurements?

a. Milligram ____________

b. Microgram ____________

c. Kilogram ____________

d. Drop ____________

e. Ounce ____________

18. Convert the following as indicated.

a. 140 ml = __________L

b. 99 gm = __________kg

c. 10 cc = __________ml

d. 180 lbs = __________kg

19. Reduce 12/18 to its lowest terms. ____________

20. Convert 9/6 to a mixed number and reduce to lowest terms. ____________

21. Add 2/7 and 6/7 and reduce. ____________

22. Add 1/2 to 3/4 ____________

23. Subtract 3/8 from 7/8 and reduce. ____________

24. Subtract 1/8 from 1/6. ____________

25. Multiply 3/4 x 2/6. ____________

218

26. Multiply 3 1/2 x 1/4 and reduce. ____________

27. Divide 3/4 by 2. ____________

28. Write the decimal numeral of 144 thousandths. ____________

29. Add 3.72 +0.015 +0.2. ____________

30. Subtract 5.82 from 7.5. ____________

31. Multiply 7.25 times 4.10. ____________

32. Divide 32.75 by 5.2. ____________

33. Convert the following decimals to a fraction and reduce.

a. 0.455

b. 0.666

c. 0.25

34. Convert the following to percentages.

a. 0.12

b. 1

c. 0.258

35. Convert the following percentages to decimals.

a. 20%

b. 12.5%

c. .05%

36. Reduce the following ratios to lowest terms.

a. 25:500

b. 32:72

c. 3:72

219

37. Which ratios are equivalent?

a. 5:1000, 100:1000

b. 20:100, 40:80

c. 13:39, 26:78

38. Select the ratio that is the stronger solution.

a. 1:25 or 25:100

b. 4:100 or 45:1000

c. 5:10 or 2:5

39. What is the abbreviation for each of the following measurements?

a. Milliliter ____________

b. Kilogram ____________

c. Gram ____________

d. Ounce ____________

e. Teaspoon ____________

f. Tablespoon ____________

g. Liter ____________

h. Drops ____________

40. Convert the following.

a. 20gms = ____________ Kilograms

b. 25mg = ____________ micrograms

c. 1 liter = ____________ milliliters

d. 200mgs = ____________ Grams

e. 650gr = ____________ milligrams

41. How many gallons of gas are needed to fill a 22-gallon tank if it is already 3/4 full?

___________________________________________________________________________________

220

42. What is the change in price of M&L laboratories if it dropped from 16 3/8 to 11 1/4 in one week?

___________________________________________________________________________________

43. How many school hours would be lost in 50 weeks (5 days per week) if a student arrived 1/4 of an hour
late 3 days per week and left 1/3 hour early each day.

___________________________________________________________________________________

44. 12 Pizzas were ordered for a class of 30 students. If the instructors ate 3/4 of the pizza, how much could
each student have if they ate equal portions?

___________________________________________________________________________________

45. What is the weekly income of a small business if the daily income was: $198.57, $276.43 $204.29,
$187.00, $56.00, and $294.63?

___________________________________________________________________________________

46. What is the total number of miles in a runners work out who ran 3.2 miles, 9.7 miles, 12.85 miles and
4.51 miles in four days of practice.

___________________________________________________________________________________

47. How many rivets are needed to make 25 pounds if each rivets weighs 0.625 pounds?

___________________________________________________________________________________

48. How many fans purchased food at the All-Star game if 54,960 attended and 59.7% purchased food?

___________________________________________________________________________________

49. The rent of a one-bedroom apartment increased from $280.00 to $294.00. What was the percentage of the
increase?

___________________________________________________________________________________

50. A professional baseball player contracts to play for $4,000,000.00 for 5 years. If he plays 162 games per
year, how much is he paid per game?

___________________________________________________________________________________

51. How many cars would a salesperson need to sell in order to make $5000.00, if the salesperson makes
$625.00 on each car?

___________________________________________________________________________________

221

NOTES/COMMENTS
222
Handbook 1 The Lymphatic System
Lesson 1.15

The Lymphatic System

Terminal Objective:

1.15 List the structures of the lymphatic system and explain their basic functions.


1.15.01 List the primary functions of the lymphatic system.

1.15.02 List and identify the components of the lymphatic system and their functions.

The lymphatic system actually is a subsystem
of the circulatory system. It collects, filters, and
returns interstitial fluid to the blood, transports
and stores lymphocytes, absorbs lipids from the
intestine and transports them to the blood.
Interstitial fluid bathes all the cells of the body. It
is rich in oxygen and nutrients. Most interstitial
fluid is returned to general circulation at the
venous end of capillaries. The rest enters the
lymphatic system where it becomes lymph which
eventually drains into venous blood through the
right and left lymphatic ducts at the junction of
the internal jugular and subclavian vein.

The lymphatic system Figure 1.15.01 consists
of lymph, lymph vessels, lymph ducts, lymph
nodes, tonsils, spleen, and thymus gland. Lymph
is a clear, watery fluid formed from interstitial
fluid. Lymph vessels begin as lymph capillaries
and unite to form larger vessels, called
lymphatics. At strategic points along lymph
vessels are lymph nodes which are oval or bean-
shaped structures. The primary functions of
lymph nodes are to filter lymph and to store
lymphocytes (WBCs) and T-cells. By filtering
and destroying bacteria found in lymph, they help
prevent the spread of infection. An infection in
any part of the body may result in swelling and
tenderness of lymph nodes draining that particular
area. Large concentrations of lymph nodes are
found in the axillary (armpit) region, the cervical
(neck) region, and the inguinal (groin) region,
Figure 1.15.01.

Lymphatics carry lymph to collecting sites,
known as lymph ducts, where it is returned to the
larger veins of the body for general circulation.
Lymphatics from the entire body, except the right
upper quadrant, drain into the thoracic lymph
duct, which drains into the left subclavian vein
(entering the right atrium of the heart).
Lymphatics from the upper right quadrant (right
arm and right side of head and neck) drain into
the right lymphatic duct. Drains into the right
subclavian vein.

The primary lymphatic organs are the bone
marrow and thymus gland. They are the sites for
production of lymphocytes and B and T cells.

The tonsils are lymph organs which are
located in the throat. The spleen is the largest
lymphatic organ. It is found behind and to the
side of the stomach, protected by the rib cage. Its
primary function is to bring blood in contact with
lymphocytes. In addition, it removes worn out
RBCs, WBCs, and platelets. The thymus gland
is located posterior to the sternum and between
the lungs. It functions as a storage for
lymphocytes and for the maturing of T-cells.

223
The Lymphatic System Handbook 1

FIGURE 1.15.01
LOCATION OF LYMPH NODES
224
Handbook 1 The Lymphatic System Worksheet
Lesson 1.15

The Lymphatic System Worksheet

1. What are the three functions of the lymphatic system?

a. _______________________

b. _______________________

c. _______________________

2. Lymph is filtered by the _______________________

3. Lymph from the upper right side of the body drains into the _______________________ lymph duct.

4. The main circulatory channels for lymph are called _______________________________.

225
The Lymphatic System Worksheet Handbook 1
NOTES/COMMENTS

226
Handbook 1 The Digestive System
Lesson 1.16

The Digestive System

Terminal Objective:

1.16 List the structures of the digestive system and explain their basic functions.


1.16.01 List the steps in the digestion process.

1.16.02 List the components of the digestive system and their functions.

The digestive system, Figure 1.16.01, is a
group of organs designed to take in foods, digest
foods, and eliminate unused materials. The
gastro-intestinal tract or alimentary canal is the
passageway where the mechanical and chemical
digestive activities take place, starting at the
mouth and going to the anus.

The digestive system carries out five basic
activities:

1. Ingestion -- taking food into the body

2. Movement of food -- passage of food along
the gastrointestinal tract.

3. Digestion -- mechanical and chemical
breakdown of food into simple molecules that
can be absorbed and used by body cells.

a. Mechanical digestion is the process of
chewing and churning of food. After food
is swallowed, it moves through the
digestive system by peristalsis.

b. Chemical digestion occurs when
enzymes aid in turning food into
solutions and simple compounds that can
be absorbed by the body.

4. Absorption -- means by which solutions
and simple compounds in the
gastrointestinal tract pass into the
cardiovascular and lymphatic systems for
distribution to cells.

5. Defecation -- elimination of substances
that can not be absorbed from the body.

In the mouth, Figure 1.16.02, the teeth
mechanically break food into small particles. The
process of chewing is call mastication. While this
is going on, the salivary glands secrete saliva
which moistens food to make it easier to chew
and swallow. Saliva initiates chemical digestion
of starches. The tongue is the organ of taste and
assists in mastication, swallowing, and speech.

The pharynx is the passageway between the
mouth and esophagus which also serves the
respiratory tract. The epiglottis is a cartilaginous
flap that covers the opening to the larynx/trachea.
It prevents food and fluids from going down the
trachea, which is commonly known as going
down the wrong pipe.

The esophagus, Figure 1.16.03, is a muscular
tube about 25 cm (10 inches) long. It connects the
pharynx and the stomach. Food is pushed down
this tube to the stomach by muscle contractions
known as peristalsis. When peristalsis is reversed,
emesis (vomiting) occurs.

227
The Digestive System Handbook I
The stomach is located between the lower
end of the esophagus and the first portion of the
small intestine. It lies in the left upper quadrant of
the abdominal cavity. The abdominal cavity is
lined with a membrane called the peritoneum.
The stomach is a pouch shaped organ that is
situated under the diaphragm. It acts as a
storehouse for swallowed material. Through
glands, the stomach secretes hydrochloric acid
and enzymes to help chemical digestion. It churns
food, with gastric juices, into a mixture called
Chyme. Very little absorption occurs in the
stomach.

The small intestine is connected to the
stomach by the pyloric sphincter. The pyloric
sphincter is a one way passage which prevents
the backflow of partially digested food from small
intestine. The small intestine, which is about 21
feet long, is lined with villi, small finers-like
projections where absorption of digested food
particles occurs.

The small intestine is divided into three
sections: the duodenum, the jejunum, and the
ileum. The small intestine is where most
absorption of food occurs. After eating, it takes
from 20 minutes to 2 hours for the first portion of
the food to pass through the small intestine. Food
is mixed in a process known as segmentation.

The large intestine is larger in diameter than
the small intestine but is much shorter, only 5 feet
long. It is divided into four major regions: cecum,
colon, rectum, and anal canal. The large
intestine receives watery food residue from the
small intestine and provides storage of flatus (gas)
and feces.

The colon is divided into four portions:
ascending colon, traverse colon, decending colon
and sigmoid colon.

The rectum curves into the short anal canal.
The anus is the external opening of the rectum. It
is closed by a strong, muscular ring called the
anal sphincter, which opens for defecation.

ACCESSORY ORGANS OF
DIGESTION

The liver is the largest gland in the body. It is
located in the right upper quadrant of the
abdominal cavity. The primary function of the
liver is to remove excess sugar from the blood
and store it for future use. The liver also stores
certain vitamins and minerals and produces bile.

The gallbladder is a pear--shaped sac which
is dark green because of the bile it contains. It is
posterior to the liver. The gallbladder receives
bile from the liver and stores it until the small
intestine is stimulated by fats. Bile is then
released to emulsify fats.

The pancreas is a large gland lying
posteriorly to the stomach. The pancreas contains
a special group of cells called the islands of
Langerhans, which secrete the hormone insulin
needed for utilization of sugar by the body. The
pancreas secretes pancreatic juices which aid in
digestion.

Figure 1.16.01 shows the pathway food takes
through the body. The structures are labeled in
order.

228
Handbook 1 The Digestive System

FIGURE 1.16.01
DIGESTIVE SYSTEM
229
The Digestive System Handbook I

FIGURE 1.16.02
UPPER DIGESTIVE SYSTEM

FIGURE 1.16.03
DIGESTIVE ORGANS
230
Handbook 1 The Digestive System Worksheet
Lesson 1.16

The Digestive System Worksheet

1. The process of converting food to a substance which can be used by the cells is:

a. mechanical digestion.

b. chemical digestion.

c. digestion.

d. defecation of waste.

2. When food is masticated and churned in the mouth _____________ is occurring.

a. mechanical digestion

b. chemical digestion

c. digestion

d. defecation of waste

3. Number the organs in order that shows the route that food takes through the alimentary tract.

a. Pharynx ______ e. Stomach ______

b. Anus ______ f. Large intestine ______

c. Esophagus ______ g. Small intestine ______

d. Mouth ______

231
The Digestive System Worksheet Handbook 1
4. Label the blanks on the following figure.

5. The greatest amount of chemical digestion occurs in the:

a. mouth.

b. stomach.

c. large intestine.

d. small intestine.
232
Handbook 1 The Digestive System Worksheet
6. Digested foods are absorbed from the:

a. mouth.

b. stomach.

c. large intestine.

d. small intestine.

7. The cecum, colon, rectum, and anal canal are sections of the:

a. mouth.

b. stomach.

c. large intestine.

d. small intestine.

8. The organ that stores, churns, and mixes food with hydrochloric acid is called the:

a. pharynx.

b. stomach.

c. large intestine.

d. small intestine.

9. Feces is stored in the:

a. anus.

b. duodenum.

c. large intestine.

d. small intestine.

233
The Digestive System Worksheet Handbook 1
NOTES/COMMENTS
234
Basic Hospital Corps School Lesson 1.19 Patient Interviewing and
Handbook 1 History Taking
Lesson 1.19

Patient Interviewing and History Taking

Terminal Objective:

1.19 Interview a patient to obtain a medical history.


1.19.01 State the purpose of a medical history.

1.19.02 List basic guidelines for obtaining a medical history.

1.19.03 List the procedures for obtaining the information required for a medical history.

1.19.04 Conduct an interview to obtain a medical history.

To conduct a patient interview, the Hospital
Corpsman must be familiar with the
communication process, confidentiality, and
interviewing techniques. Communication is the
interpersonal process of people relating to each
other through conversation, writing, gestures,
appearance, behavior and silence. It is through
the communication process that the Hospital
Corpsman is able to promote honest, open, and
effective interaction with a patient.
Communication is a tool which aids in identifying
the needs of the patient, as well as the goals of the
Navy health care system.

The situation will impact the patient
interview. The Hospital Corpsman must be able
to determine when it is appropriate to deviate
from the general guidelines for conducting an
interview. The interview for a patient's medical
history is much different from an interview at the
scene of an accident, but there are significant
similarities.

PURPOSE OF HISTORY TAKING

The medical history is an account of events in
the patient's life that have relevance to mental,
emotional, and physical health. The medical
history is the first step in the health care process.
It should be as complete as possible to
provide the data necessary to evaluate a patient's
condition at the time.

Although the medical history will vary from
patient to patient, the purpose remains to:

1. Establish patient contact and rapport

2. Provide a focal point for the physical
assessment

3. Aid in ordering tests to arrive at an accurate
diagnosis and instituting appropriate
treatment.

GUIDELINES FOR OBTAINING A
MEDICAL HISTORY

Confidentiality of all communication is of
utmost importance. Every patient has the right to
withhold personal information from public
knowledge. At the beginning of the interview,
assure the patient that information will be kept
confidential. Explain that the information will be
shared with other medical professionals to ensure
an appropriate care plan is developed.

235
Lesson 1.20 Patient Interviewing and Basic Hospital Corps School
History Taking Handbook 1
The legal issue of invasion of privacy relates
to confidentiality. Medical treatment is, by its
nature, an invasion of an individual's privacy.
Health care providers must be careful to obtain
the patient's permission before treatment and to
conduct the care in an appropriate manner. If a
person is exposed to the public either personally
or through photographs, the person responsible
for the exposure may be sued for invasion of
privacy unless consent was given. A careless
Hospital Corpsman who unnecessarily exposes a
patient during treatment or during transportation
through the corridors may be guilty of invasion of
privacy. Gossiping about a patient's condition to
persons without a need to know also constitutes
invasion of privacy.

PROCEDURES FOR OBTAINING A
MEDICAL HISTORY

Prepare the environment before the patient
arrives. The interview should be conducted in
private. The patient may be unwilling to tell what
problems are being experienced if he/she believes
the conversation can be overheard. A quiet
location, away from interruptions facilitates
gathering a complete medical history. Supplies
for taking notes and standard forms should be
taken to the interview. Ensure that seating is
available so that you and the patient can see each
other. Before beginning the interview, check the
patient's identifying data. The patient's age, sex,
marital status, race, occupation, and address
provide clues to the patient's likely life
experiences and may assist in constructing a
diagnostic hypothesis.

The interview begins with greeting the
patient. Use the patient's name and appropriate
title, e.g., Petty Officer J ohnson or Mrs. Smith.
Do NOT use an adult patient's first name.
Introduce yourself.

From the outset of the interview, observe the
patient for signs of discomfort, anxiety, and pain.
Making the patient comfortable will help him/her
focus on the interview, which will aid in
acquiring a complete history. If the patient is
uncomfortable, specific information may be
forgotten or neglected to shorten the interview. If
this seems to be occurring, the interview should
be delayed until the patient is more comfortable.

The patient must be able to relate the history
and symptoms of the illness without diversion.
Language and terms used during the interview
must be understandable to the patient. specific
information is obtained by asking direct
questions. The interview should proceed from
general inquiries to specific questions concerning
the current problem. Avoid leading questions.
Questions should require a detailed response
instead of a "yes" or "no" answer. Such questions
usually start with when, where, how, or why.

There are several interview techniques which
will assist in obtaining a complete medical history
in the patient's own words. Facilitation
encourages the patient to continue speaking
without the interviewer imposing words. This
includes eye contact, posture, words of
encouragement, and gestures. An example is,
nodding and asking, What happened next?

Reflection involves the interviewer repeating
what the patient has already said to encourage the
patient to elaborate. This is frequently done by
restating something the patient has said as an
open-ended question. For example, after a patient
stated he felt a pain in his left leg, the interviewer
might respond, So your left leg hurts? Allowing
the voice to trail off into an implied question.

At times the patient may attempt to express
feelings or information which he/she is
embarrassed or ashamed to admit. Uncovering the
condition or feelings may be necessary to
understand the illness or plan treatment.
Empathetic responses allow you to show
understanding and acceptance. Displaying
empathy makes the patient feel more secure and
encourages communication. Empathetic
responses include nodding, smiling, and
supportive words.

Confrontation is pointing out to the patient
inconsistencies in words and behaviors.
Confrontation should NOT be used if other
techniques can draw the patient into a meaningful
interview. Confrontation can be achieved by
pointing out signs which are inconsistent with the
236
Basic Hospital Corps School Lesson 1.19 Patient Interviewing and
Handbook 1 History Taking

patient's complaint. If signs of anger, anxiety, or
depression are observed, confrontation may be
instrumental in encouraging the patient to
verbalize these feelings.

J ust as you have been making observations of
the patient during the interview, he/she has been
observing you. You have been sending verbal and
nonverbal messages. Posture, gestures, eye
contact, and words can express interest, attention,
acceptance and understanding. A skilled
interviewer can control personal reactions that
block communication, including expressions
which might be interpreted as disapproval,
impatience, or boredom.

When taking a medical history, there is a
standard sequence which you should follow as
closely as possible. Following a standard
sequence will help ensure that you do not miss
anything that might be important in your overall
approach to the patient and will assist you when it
is time to record your findings.

As you begin taking the medical history,
remember that it is important to listen to what the
patient is saying, avoid interrupting unless you
really have to and do not prepare the next
question before you have heard the complete
answer to the last question asked.

The following sequence is a guide in eliciting
and recording a comprehensive medical history.

1. INTRODUCE YOURSELF TO THE
PATIENT. Give your rating and name

2. PATIENT IDENTIFICATION -- Verify the
patient's name, social security number, age,
marital status, etc.

3. CHIEF COMPLAINT -- Reason the patient
sought health care. This should be stated in
the patient's own words, if possible. (Use
quotes to document.) Why are you here?
What hurts? What happened? For how long?

4. PRESENT ILLNESS -- List and describe
current symptoms of the chief complaint and
their appearance in chronological order.
Include the following details of symptom
occurrence:

Time intervals -- Time of day, duration, etc.
When did it happen?

a. Character or quality -- Severity, location,
and nature. What kind of symptoms?

b. Association with certain events -- Eating,
activity, etc. How did it happen? How
bad is it?

c. Treatments -- Those attempted and their
outcome. What have you done to fix it?

d. Interference with daily living. What
makes it better or worse?

5. PAST MEDICAL HISTORY:

Allergies.

a. Hospitalization or treatment.

b. Illnesses.

c. Current health habits or risk factors --
exercise, smoking, alcohol.

d. Current medications -- Both prescription
and over the counter.

6. FAMILY HISTORY -- Include family
members and any major health or genetic
disorders. Questions include: Does anyone
in your family have this illness/problem?

7. PERSONAL/SOCIAL HISTORY -- Cultural
background, educational and economic status,
environment. Questions include: How many
hours do you sleep at night? What are your
eating habits? Do you live along? do you
have transportation?

8. REVIEW OF SYSTEMS -- Organize in a
general head-to-toe sequence and include an
impression of each symptom. The following
categories of information are generally
included, but the sequence may vary:

237
Lesson 1.20 Patient Interviewing and Basic Hospital Corps School
History Taking Handbook 1
General overview. How would you describe
your overall health? h. Integumentary.

As the interview approaches its end, it is
possible to return to the more free-flowing style
of interviewing. At the end, review the discussion
and ask the patient for anything that might have
been missed. Now that you have completed the
history, it is time to go into the actual physical
examination.
a. Neurological.

b. Cardiovascular.

c. Respiratory.

d. Gastrointestinal.

All information gathered from the patient (or
patient's family) is documented on the appropriate
health record form. (Health record forms will be
taught later in the course.)
e. Genitourinary.

f. Musculoskeletal

g. Psychiatric.

238
Basic Hospital Corps School Lesson 1.19 Patient Interviewing and History
Handbook 1 Taking Worksheet
Lesson 1.19

Patient Interviewing and
History Taking Worksheet

1. What are the purposes for obtaining a medical history?

a. _________________________________________________________________________

b. _________________________________________________________________________

c. _________________________________________________________________________

2. Why is it important to provide privacy when communicating with a patient?

_________________________________________________________________________

3. When is it acceptable to disclose information about a patient to someone?

_________________________________________________________________________

4. How should a patient be addressed?

_________________________________________________________________________

5. What type of question should the interview begin with?

_________________________________________________________________________

6. Define facilitation related to taking a medical history.

_________________________________________________________________________

_________________________________________________________________________

7. What term describes responding in a way that shows understanding and acceptance?

_________________________________________________________________________

8. What method of directing communication involves repeating the patient's words in order to prompt
him/her to give more information?

_________________________________________________________________________

9. A patient's medical history is an account of life events that have relevance to his/her ________________,

________________ and ________________ health.
239
Lesson 1.19 Patient Interviewing and History Basic Hospital Corps School
Taking Worksheet Handbook 1

10. List the elements of a complete medical history.

a. ________________________________________________________

b. ________________________________________________________

c. ________________________________________________________

d. ________________________________________________________

e. ________________________________________________________

f. ________________________________________________________

11. List three questions you could ask to elicit a patient's chief complaint.

a. ______________________________________________________________________________

b. ______________________________________________________________________________

c. ______________________________________________________________________________

12. In soliciting a patient's medical history, the first thing to do is:

__________________________________________________________________________________

13. List five items included in a patient's past medical history.

a. ________________________________________________________

b. ________________________________________________________

c. ________________________________________________________

d. ________________________________________________________

e. ________________________________________________________

14. Questions asked while taking a medical history usually begin with:

a. ________________________________________________________

b. ________________________________________________________

c. ________________________________________________________

d. ________________________________________________________

240
Basic Hospital Corps School Lesson 1.20 Principles and Concepts of
Handbook 1 Medical Asepsis
Lesson 1.20

Principles and Concepts of
Medical Asepsis

Terminal Objective:

1.20 List concepts and principles of medical asepsis.


1.20.01 Define terminology pertaining to medical asepsis.

1.20.02 List the components of the chain of infection.

1.20.03 List the body's natural defense against infection and factors that weaken those defenses.

1.20.04 List medical aseptic techniques.

1.20.05 List hand washing procedures for using soap and water as well as hand sanitizer.

Microorganisms are everywhere in the
environment - in the air, water, food, and on
every object. They are found on the skin and in
the body. Most are harmless, but some are
capable of causing disease or infection. A
priority of health care personnel is to prevent the
spread of these microorganisms to protect
themselves and patients from acquiring a disease
or infection.

GLOSSARY

SEPSIS -- State of infection.

ASEPSIS -- Absence of infection.

MEDICAL ASEPSIS -- Practices that
reduce the number and spread of microorganisms.
Also called clean technique.

MICROORGANISM -- A tiny, living
animal or plant, that can only be seen with a
microscope. Always present in the environment
unless special measures are taken to eliminate it.

PATHOGEN -- Microorganism that causes
infection and contagious disease.

NONPATHOGEN -- Any nondisease
producing microorganism.

CONTAMINATION -- To make something
unclean or unsterile.

CROSS CONTAMINATION -- The
transfer of pathogens from one person to another,
the transfer of pathogens from one area to
another, or to transfer pathogens from equipment
to a person

DISINFECTION -- Process by which
pathogens on equipment are destroyed. Does not
necessarily kill their spores.

DISINFECTANT A chemical that kills
mricoorganisms but not their spore.

ANTIMICROBIAL AGENT -- A chemical
that kills or suppresses the growth and
241
Lesson 1.20 Principles and Concepts of Basic Hospital Corps School
Medical Asepsis Handbook 1
reproduction of microorganisms. synonym for
anti-infective agent.

ANTISEPTIC -- Prevents or inhibits the
growth of microorganisms. Safe to use on living
tissues.

TERMINAL DISINFECTION -- Cleaning
of contaminated equipment and supplies after the
patient's discharge.

NOSOCOMIAL INFECTION -- Infection
acquired in a hospital setting

SURGICAL ASEPSIS -- practices that
render and keep objects free of all
microorganisms. also known as "sterile
technique."

THE CHAIN OF INFECTION

The chain of infection, Figure 1.20.01,
describe the transmission and spread of disease.
Methods of controlling the pathogens are based
on interrupting the chain of infection and spread
of these microorganisms. The links of the chain
are:

1. Reservoir -- The place where pathogens
grow and reproduce. Includes people,
animals, and food.

2. Means of Exit from the Reservoir -- The
route of escape for a pathogen, such as the
nose, throat, mouth, intestinal tract, urinary
tract, and wounds.

3. Vehicle of Transmission -- The manner by
which a pathogen moves from one source to
another, such as human touch, airborne
droplets from respiratory system, vehicles
(like silverware, medical instruments) or
vectors (mosquitoes, vermin).

4. Portal of entry -- Place where pathogen
enters the body, e.g., break in skin, mucous
membranes, mouth, nose, and genitourinary
tract.

5. Susceptible host -- An individual whose
body cannot fight off organisms. Once
microorganisms enter the body, illness
usually occurs.

MEDICAL ASEPSIS

Medical asepsis are practices that confine or
reduce the number of microorganisms that may
enter the body. Examples of medical asepsis are
personal hygiene practices, such as hand washing,
and environment disinfections. Items are called
clean when medical asepsis is used. Medical
asepsis does not destroy all organisms, it only
reduces the number and spread of organisms.

When proper medical asepsis is not followed,
e.g.. neglecting frequent hand washing, patients
with already weakened defenses are at increased
risk of infection.

BODY DEFENSES AGAINST
DISEASE

The human body is equipped with defenses to
resist being overcome by microorganisms and
subsequent infection or disease. Natural body
defenses against harmful microorganisms include:

1. Intact skin and mucous membranes: The
unbroken surfaces act as barriers preventing
pathogens from entering the body.

2. Body hair: Hair on or within the body traps
and holds particles that contain
microorganisms.

3. Body secretions: Saliva, mucous, tears,
perspiration, gastric enzymes, and urine
contain chemicals that weaken or destroy
pathogens.

4. Reflexes: Sneezing, coughing, blinking,
tearing, and vomiting occur spontaneously to
expel microorganisms.

5. Inflammatory response and immune
response: The body is able to produce
specialized cells (antibodies) and chemicals
that inhibit the growth and spread of
pathogens.

242

6. Temperature regulation: When the body's
temperature is raised above the normal range,
organisms can be destroyed or weaken by
heat.

7. Cell repair and replacement: New cells are
manufactured that repair and replace cells that
are diseased, injured or destroyed. These new
cell protect the body from further invasion.

FACTORS WHICH WEAKEN
NATURAL BODY DEFENSES

Changes can occur that weaken a person's
normal defenses against microorganisms.
Without proper nutrients to grow, maintain, and
repair cells.

Daily and more frequent personal hygiene
removes microorganisms from skin, hair, under
nails and in the mouth. Trapped microorganisms
accumulate and provide for growth and
reproduction. Once the natural barrier, the skin or
mucous membranes, has been broken,
microorganisms can invade susceptible areas of
the body. Such breaks include cuts, incisions, and
burns.

Many natural defenses are not fully
developed in newborn infants and so they are at
high risk for infections. The defense mechanisms
of the elderly are not always functioning at an
optimum level which also places them at risk.

The entire body is affected when disease is
present. The body's reserves to fight infection
may be reduced or completely expended. Some
drugs and medical treatments reduce the body's
defense mechanisms, e.g. Steroids used to treat
arthritis, cancer or transplants patients.

Stress reduces the body's ability to resist disease.

MEDICAL ASEPSIS PRACTICES

Hand washing is the SINGLE most effective
means of preventing the spread of disease. There
are other practices that reduce the spread of
disease, including:
1. Follow Universal Precautions to protect
yourself and patients from acquiring
infections transmitted via blood or body
fluids. This includes using gowns, goggles,
mask, and other protective gear when needed
to prevent contact with blood or body fluids.

2. Handle all patient excretions as if they
contain pathogens. use clean gloves when
handling any body secretions, e.g., urine,
feces, sputum, or emesis.

3. Carry out careful, complete terminal
disinfection upon patient discharge according
to local policy.

4. Wrap wet or damp items such as dressings or
bandages in a waterproof bag before
discarding so that trash handlers will not
come into contact with infectious drainage.
(These will be placed in a biohazardous waste
container for proper disposal.)

5. Always consider the floor heavily
contaminated. If an item falls on the floor,
discard or disinfect it.

6. Flush contents of bedpans and urinals
promptly, unless they are being saved as a
specimen.

7. Use equipment and supplies for one patient
only. Disinfect reusable equipment between
uses.

8. Keep soiled equipment or linen away from
your uniform so that organisms are not
carried between patients.

9. Avoid raising dust which can carry
microorganisms. Do not shake linen; it only
raises dust. Wet mop and damp dust.

10. Avoid spilling bath water and mouthwash
rinsing on your uniform or the floor.

11. Keep patient rooms clean bright and airy.
Microorganisms do not grow well in this
environment.

243
12. Avoid wearing rings with grooves or stones
because they are difficult to keep clean and
may scratch the patient.

13. Maintain good personal hygiene

a. Keep hair short or secured of long
because hair can carry microorganisms.

b. Keep fingernails short, well groomed and
clean. Chipped nail polish, hang nails,
and rings can harbor organisms.

c. Wash hands before handling food.

d. Shower or bathing daily to prevent
growth of microorganisms.

e. Wear a clean uniform each day.

f. Wash hands after using the bathroom.

14. Avoid sitting on a patient's bed. The bed may
be contaminated with pathogens which could
be carried to another patient.

15. Follow local policies for cleaning equipment.

PROCEDURES FOR HAND
WASHING

Good hand washing is essential before and
after giving nursing care or handling equipment to
prevent the spread of microorganisms from staff
to patient, patient to patient, patient to staff, and
staff to home. The procedure for washing hands
is:

1. Remove jewelry from hands and wrist; push
up watch.

Reason -- J ewelry harbors microorganisms.

2. Avoid leaning on sink.

Reason -- Sink is always considered
contaminated.

For soap and water

1. Turn on water to warm, comfortable
temperature.

Reason -- Makes better soapsuds.

2. Control water flow to keep from splashing.

Reason -- Water splashed from contaminated
sink will spread organisms to uniforms.

3. Wet hands and wrists and apply
antibacterial/antiseptic soap and suds. Liquid
soap is best. Bar soap and soap dishes are
considered contaminated.

Wash palms, backs of hands, fingers,
fingernails, wrists, and forearms with firm,
rubbing, circular motions, 10 seconds to 2
minutes, depending on the potential for
contamination.

Reason -- Friction caused by firm rubbing
and circular motions helps loosen dirt and
organisms. Fingernails harbor pathogens.

4. Rinse hands, wrists, and forearms under
running water. Keep hands and forearms
HIGHER than elbows.

Reason -- Running water rinses away the dirt
and organisms which have been loosened
with soap, water and friction. Gravity allows
the rinse water to drain from less
contaminated areas to the more contaminated
area.

5. Dry completely with as many paper towels as
necessary.

Reason -- Drying prevents chapping.

6. Turn off faucet using paper towel.

Reason -- Touching faucet with clean hands
leads to recontamination.

244

For hand sanitizer:

1. Place a thumbnail size amount in the
palm of your hand.
2. Rub the fingertips and fingernails of the
opposite hand into the sanitizer.
3. Transfer some of the sanitizer to the other
hand and repeat the fingernail cleaning
procedure.
4. Rub hands briskly until dry.
5. Apply lotion to forearms, wrists, and
hands.

Reason -- Helps prevent chapping. Chapped
skin is a reservoir for microbes.

Utilizing these practices will do much to
prevent the spread of disease and infection.
Lack of attention by even one person could be
detrimental to the health of patients and staff.

FIGURE 1.20.01
CHAIN OF INFECTION
245
NOTES/COMMENTS
246
Handbook 1 Medical Asepsis Worksheet
Lesson 1.20

Principles and Concepts of
Medical Asepsis Worksheet

1. Medical asepsis is the same as sterile technique.

a. True b. False

2. A solution used to prevent or inhibit the growth of microorganisms that is safe to use on living tissue is
called: _______________________________.

3. A microscopic living animal or plant is a _______________________________.

4. A disease producing organism is called a/an:

a. antibody.

b. antigen.

c. pathogen.

d. antibiotic.

5. What is another name for medical asepsis? ____________________________________________.

6. Medical asepsis destroys all organisms.

a. True b. False

7. An example of a personal hygiene practice used to prevent entry of organisms into the body
is _______________________________________________________.

8. Circle each body defense against disease.

a. Body hair

b. Body secretions

c. Reflexes

9. When a persons natural defenses are weakened, he/she is at risk of acquiring an infection.

a. True b. False

247
Medical Asepsis Worksheet Handbook 1
10. List four factors that weaken the body's natural defenses.

a. _________________________________

b. _________________________________

c. _________________________________

d. ________________________________

11. Two age groups that are particularly susceptible to pathogenic organisms are ___________________
and ___________________.

12. Hand washing should be done before and after giving patient care or handling equipment.

a. True b. False

13. Hand washing prevents the transfer of microorganisms from:

a. _________________________________

b. _________________________________

c. _________________________________

d. ________________________________

14. Bar soap is preferred for handwashing.

a. True b. False

15. Prior to handwashing, remove ______________________________________

16. When handling any body secretions, _________________________________.

17. Equipment and supplies are to be used for only one patient at a time and disinfected before use on another
patient.

a. True b. False

18. List four medical asepsis practices.

a. ______________________________

b. ______________________________

c. ______________________________

d. ______________________________

248 246
APPENDIX 1

COMMONLY USED ABBREVIATIONS

(ABBREVIATIONS IN PARENTHESES ARE ALSO COMMON IN MEDICAL WRITING)

A

a.....................................before
A....................................Assessment
A....................................admitted to
hospital
A2..................................aortic 2nd sound
aa...................................of each
AB.................................abortion
ABD..............................abdominal
ABE ..............................acute bacterial
endocarditis
AGB..............................arterial blood
gases
abbr ...............................abbreviations
ac...................................before meals
ACDU...........................active duty
ACTH............................adrenocorticotropic
hormone
AD.................................right ear
ADH..............................antidiuretic
hormone
ADL ..............................activities of
daily living
ADM.............................admission, admitted
ad lib.............................as desired
AFB...............................acid-fast bacillus
AJ ..................................ankle jerk
AK.................................above knee
AKA..............................above knee
amputation
ALB (alb)......................albumin
A-line............................arterial line
ALK ..............................alkaline
AM (a.m.) .....................morning

AMA.............................against medical
advice
amp...............................ampule
AMP .............................amputation
AMT .............................amount
ANES............................anesthesia
ANT..............................anterior
AOD.............................administrative
officer of the
day
AODM..........................adult onset
diabetes mellitus
AOL..............................away over leave
AOW.............................admitted from other
......................................ward
A&P..............................anterior and
posterior
AS.................................left ear
ASAP............................as soon as possible
ASCVD.........................arteriosclerotic/
atherosclerotic
cardiovascular
disease
ASD..............................atrial septal
defect
ASHD...........................arteriosclerotic
heart disease
ASOT............................antistreptolysin O
titer
ATN..............................acute tubular
necrosis
AU................................both ears
AV ................................arteriovenous
AWOL ..........................absent without
leave

A-1-1
B

Ba..................................barium
BBB ..............................bundle branch
block
BCP...............................birth control pill
BE.................................barium enema
BID (b.i.d.)....................twice a day
BILI...............................bilirubin
BK.................................biceps jerk
BK.................................below knee
BKA..............................below knee
amputation
BM................................bowel movement
BMR..............................basal metabolism
rate
BP.................................blood pressure
BPH..............................benign prostatic
hypertrophy
BR.................................bed rest
BRP...............................bathroom privileges
BRcBRP........................bed rest wth
bathroom
privileges
BS.................................blood sugar
BSP...............................bromsulphalein
BRL ..............................bilateral tubal
ligation
BUN..............................blood urea nitrogen
BX (Bx) ........................biops

C

c.....................................with
C....................................Celsius
(centigrade)
C1, 2, ets.......................cervical 1, 2, etc.
CA.................................cancer
carcinoma
CA.................................calcium
CAL ..............................calorie
cap.................................capacity
capsule
CATH (cath) .................catheter
CAT scan......................computerized
axial tomography
scan
CAC..............................Caucasian
CBC..............................complete blood
count
cc...................................cubic centimeter
CC.................................chief complaint
CCU..............................coronary care unit
CF..................................cystic fibrosis
CHF...............................congestive heart
failure
CHO..............................carbohydrate
CHOL (chol).................cholesterol
C1..................................chloride
CL .................................convalescent leave
CLR...............................census last report

C/M...............................corpsman
cm.................................centimeter
CMAA ..........................chief master-at-
arms
CNS..............................central nervous
system
CO.................................Commanding Officer
CO2...............................carbon dioxide
C/O...............................complains of
cont...............................continue
continuously
COPD...........................chronic obstructive
pulmonary disease
CP.................................cardiopulmonary
CPD..............................cephalopelvic
disproportion
CPK ..............................creatinine
phosphokinase
CPR...............................cardiopulmonary
resuscitation
CRP...............................c-reactive protein
CS.................................cervical spine
Caesarean section
C&S..............................culture and
sensitivity
CSF...............................cerebrospinal fluid
CSS...............................central sterile
supply

A-1-2
CV.................................cardiovascular
central venous
CVA..............................cerebrovascular
accident

CVP..............................central venous
pressure
CX.................................cervix
CXR..............................chest x-ray
Cysto.............................cystoscopy

D

D....................................discharged
DC.................................discontinue
D&C..............................dilatation and
curettage
DD.................................discharged by death
DEC..............................deceased
DEP...............................dependent
DEP/D...........................dependent daughter
DEP/F............................dependent father
DEP/FIL........................dependent father-
in-law
DEP/H...........................dependent husband
DEP/M..........................dependent mother
DEP/MIL ......................dependent mother-
in-law
DEP/S............................dependent son
DEP/W..........................dependent wife
DEPT ............................department
DERM (Derm) ..............dermatology
DIFF..............................differential
DM................................diabetes mellitus
DOA..............................dead on arrival

DOB..............................date of birth
DOD.............................day of delivery
DOS..............................day of surgery
DP.................................dorsalis pedis
DPT...............................diphtheria,
pertussis, and
tetanus
dr...................................dram
DR.................................doctor
DRSG...........................dressing
DSD..............................dry sterile
dressing
DT.................................delirium tremens
DTR..............................deep tendon reflex
DU................................diagnosis
undetermined
D5NS............................5% dextrose in
normal saline
D5RL ............................5% dextrose in
Ringer's lactate
D5W.............................5% dextrose in
water
E

ea...................................each
EBL...............................estimated blood
loss
EC.................................enteric coated
ECF...............................extracellular
fluid
ECG (EKG)...................electrocardiogram
ECHO............................echocardiogram
EDC..............................estimated date of
confinement
EEG...............................electroencephalo-
gram
EENT ............................eye, ear, nose, and
throat
ELIX (elix)....................elixir
ENT...............................ear, nose, and
throat
EOM.............................extraocular
movement
EOS...............................eosinophils
EPIS..............................episiotomy
EPITH...........................epithelial
ER.................................emergency room
ESR...............................erythrocyte
sedimentation
rate
EST...............................electroshock
therapy
ET .................................endotracheal
ETH..............................elixir terpin
hydrate
ETH/C...........................elixir terpin
Hydrate with

A-1-3
ETOH............................ethyl alcohol
EXAM (exam) ..............examination
exp.................................expended

ext.................................extended
extension
EXT (ext)......................extract
F

F....................................Fahrenheit
FB..................................foreign body
FBS...............................fasting blood
sugar
Fe..................................iron
FFP................................fresh frozen plasma
FH.................................family history
FHR...............................fetal heart rate
FHT...............................fetal heart tones
fl oz...............................fluid ounce
FOR/MIL ......................foreign military

FR.................................French, catheter
(use only with a
number)
FRC...............................functional residual
capacity
ft....................................foot, feet (only as
measurement)
FUO..............................fever of
undetermined
origin
FX (fx)..........................fracture
G

g (gm)............................gram
ga...................................gauge
GA.................................gastric analysis
GB.................................gallbladder
GC.................................gonococcus
GI ..................................gastrointestinal
gr...................................grain

GRAV i.........................primigravida
GSW.............................gunshot wound
gtt..................................drop
GTT ..............................glucose tolerance
......................................test
GU................................genitourinary
GYN .............................gynecology
H

h....................................hour
H....................................hydrogen
H2O...............................water
HA.................................headache
HCG..............................human chorionic
gonadotropin
HC1...............................hydrochloric acid
hydrochloride
HCT (hct)......................hematocrit
HEENT .........................head, eyes, ear,
nose, and throat
Hg..................................mercury
HG (hgb).......................hemoglobin

HNP..............................herniated nucleus
pulposus
HOSP............................hospital
H&P..............................history and
physical
HP.................................head privileges
hr...................................hour
HR.................................heart rate
HS (hs)..........................(hora somni) on
retiring
ht...................................height
HTN..............................hypertension
HX (Hx)........................history

A-1-4
I

I .....................................ioding
IBC................................iron-binding
capacity
ICP................................intracranial
pressure
ICU................................intensive care unit
ID..................................identification
I&D...............................incision and
drainage
I/E..................................inspiratory/
expiratory ratio
IM..................................intramuscular
IMP...............................impression

in...................................inch
INCR (incr)...................increased
increasing
I&O...............................intake and output
IPPB..............................intermittent
positive pressure
breathing
IV..................................intravenous
IVP................................intravenous
pyelogram
IVPB.............................intravenous
piggyback

K

K....................................potassium
KC1...............................potassium chloride
kg..................................kilogram
KJ ..................................knee jerk
KUB..............................kidney, urethers,
bladder
KVO.............................keep vein open

L

l .....................................liter
L ....................................left
liberty
LAB (lab)......................laboratory
LAT...............................lateral
lb...................................pound
LBBB............................left bundle branch
block
LBP...............................lower back pain
LDH..............................lactic
dehydrogenase
LFT ...............................liver function test
lg...................................large
LGA ..............................large for
gestational age
LIB................................liberty
LIQ................................liquid
LLE...............................left lower
extremity
LLL ...............................left lower lobe
LLQ..............................left lower quadrant
LMP..............................last menstrual
period
LNMP...........................last normal
menstrual period
LOA..............................left
occipitoanterior
LOC..............................loss of
consciousness
LOP...............................left
occipitoposterior
LP .................................lumbar puncture
LPN...............................licensed practical
nurse
LUE ..............................left upper
extremity
LUL ..............................left upper lobe
LUQ..............................left upper quadrant
lymphs..........................lymphocytes

A-1-5
M

m...................................meter
minim (equivalent
to a drop)
MAA.............................master-at-arms
MAR.............................Medication
Administration
Record
mcg................................microgram
MED..............................medical
medicine
meq (mEq) ....................milliequivalent
mg.................................milligram
Mg.................................magnesium
MI .................................myocardial
infraction
min................................minute
minim
ml ..................................milliliter
mm................................millimeter
MO................................Medical Officer
MOD.............................Medical Officer of
the Day
MVA.............................motor vehicle
accident

N

N....................................nitrogen
Na..................................sodium
NA.................................nurse's assistant
N/A................................not applicable
NaC1.............................sodium chloride
(salt)
NEG..............................negative
NEURO.........................neurology
NG.................................nasogastric
NGU..............................nongonococcal
urethritis
NIS................................not in stock
No..................................number
NOC..............................night
NOD..............................nurse of the day
NOK..............................next of kin
NP.................................neuropsychiatric
NPH..............................neutral protamine
hegedorn
NPN..............................nonprotein nitrogen
NPO..............................nothing by mouth
NS.................................normal saline
NSR..............................Normal sinus
rhythm
NSS...............................normal saline
solution
NST...............................non-stress test
NSU..............................nonspecific
urethritis
NT.................................nasotracheal
N&V .............................nausea and
vomiting

O

O....................................Objective
O....................................oral
O2..................................oxygen
o2 sat.............................oxygen saturation
ob..................................obstetrics
obst (OBST)..................obstruction
OCC..............................occupied
OCT ..............................Oxytocin Challenge
......................................Test
OD.................................right eye
oint................................ointment
OM................................otitis media
OOB..............................out of bed
OOD..............................Officer of the Day

OP.................................operation
O&P..............................ova and parasites
OPD..............................outpatient
......................................department
OPS...............................outpatient service
OR.................................operating room
ORIF.............................open reduction with
......................................internal fixation
ORTHO........................orthopedics
OS.................................left eye
OT.................................occupational
......................................therapy
OU................................both eyes
oz..................................ounch
A-1-6
P

P....................................Plan
phosphorus
pulse
P....................................after
P2..................................pulmonic second
sound
PA .................................physician's
assistant
PA&LAT ......................posterioanterior
and lateral
PAC...............................premature atrial
contraction
PAL...............................prisoner at large
Pap................................Papanicolaou's test
(smear)
PAT...............................paroxysmal atrial
tachycardia
PC..................................after meals
pCO2.............................partial pressure of
carbon dioxide
PDA ..............................patent ductus
arteriosus
PDR...............................Physician's Desk
Reference
PE..................................physical
examination
PEDS.............................pediatrics
per .................................through
by means of
PERLA..........................pupils equal, and
react to light
and
accommodation
pH..................................hydrogen ion
concentration
PH.................................past history
......................................public health
PHAR............................pharmacy
PI ...................................present illness
PID................................pelvic Inflammatory
PKU..............................phenyiketonuria
PM (p.m.)......................afternoon
evening
PO (p.o.) .......................by mouth
PO2...............................partial pressure of
oxygen
POD..............................postoperative day
POSTOP.......................postoperative
POV..............................privately owned
vehicle
PPD...............................purified protein
derivative
pr...................................pair
PR.................................per rectum
PREG............................pregnant
PREOP..........................preoperative
PREP.............................prepare
PRN (prn) .....................(pro re nata) when
necessary
PRO..............................prothrombin
PROCTO......................proctosigmoidoscopy
PROM...........................premature rupture
of membranes
PSP ...............................phenolsulfonphthal-
ein
pt...................................pint
patient
PT .................................prothrombin time
physical therapy
PTA...............................prior to admission
PTT...............................partial
thromboplastin
test
PUND...........................pregnancy, uterine,
not delivered
PVC..............................premature
ventricular
contraction

A-1-7
Q

Q (q)..............................every
QAM (qam)...................every morning
QD (qd).........................every day
QH (qh).........................every hour
Q2H (q2h).....................every 2 hours
Q3H (q3h).....................every 3 hours
Q4H (q4h).....................every 4 hours
Q6H (q6h).....................every 6 hours
Q8H (q8h).....................every 8 hours
QID (q.i.d.)....................four times a day

QNS (q.n.s.)..................quantity not
sufficient
QOD (q.o.d.).................every other day
QS (qs)..........................quantity sufficient
(sufficient
quantity)
qt...................................quart
QUAL ...........................quality
qualitative
QUANT........................quantity
quantitative
R

R....................................right
rectal
respiration
RBBB............................right bundle branch
block
RBC (rbc)......................red blood cell
red blood count
RDS...............................respiratory
distress
syndrome
REG..............................regular
REHAB.........................rehabilitation
REL...............................religion
REM..............................rapid eye movement
RESP.............................respirator
respiratory
Rh..................................Rhesus factor
RL .................................Ringer's lactate

RLE...............................right lower
extremity
RLL...............................right lower lobe
RLQ..............................right lower
quadrant
R&M.............................routine and
microscopic
RML .............................right middle lobe
RN.................................registered nurse
R/O...............................rule out
ROM.............................range of motion
RUE..............................right upper
extremity
RUL ..............................right upper lobe
RUQ..............................right upper
quadrant
RX (Rx) ........................take
treatment
S

s.....................................without
S....................................Subjective
SA .................................sinoarial
S&A ..............................sugar and acetone
SAH..............................subsist at home
SBE...............................subacute bacterial
endocarditis
SC (sc)...........................subcutaneous
SF..................................standard form
SG (sp gr)......................specific gravity
SGA ..............................small for
gestational age

SGD straight gravity
drainage
SGOT............................serum glutamic-
oxaloacetic
transaminase
SH.................................social history
SL .................................seriously ill list
SO.................................significant other
SOB..............................short of breath
SOL (sol) ......................solution

A-1-8
SOP...............................standard operating
procedure
STAT (stat)...................immediately
SOS (sos) ......................(si opus site) if
necessary (one
time only)
SP (sp)...........................spirit
SPEC (spec)..................specimen
SR..................................sedimentation rate
ss...................................one-half
S/S.................................signs and symptoms
SSE................................soap solution enema
STAPH (Staph).............staphylococcus
STD...............................sexually transmitted
disease
STREP (Strep)..............streptococcus
STS...............................serological test
for syphilis
STSG............................split thickness
skin graft
SURG...........................surgical
SUSP.............................suspension
SX (Sx).........................signs, symptoms

T

T....................................temperature
T&A..............................tonsillectomy and
adenoidectomy
TAB ..............................tablet
TAH..............................total abdominal
hysterectomy
TB.................................tuberculosis
tbsp................................tablespoonful
TC.................................throat culture
TCDB............................turn, cough, deep
breathe
TID (t.i.d.).....................three times a day
TINCT...........................tincture
TM ................................tympanic membrane
TNTC............................too numerous to
count

TO.................................telephone order
tol ..................................tolerated
TOW.............................transfer to other
ward
RP.................................total protein
TPN...............................total parenteral
nutrition
TPR...............................temperature, pulse,
and respiration
tr....................................tincture
tsp.................................teaspoonful
RURP............................transurethral
resection of
prostate
TVH..............................total vaginal
hysterectomy
TWE .............................tap water enema

U

U....................................unit
UA.................................unauthorized
absence
urinalysis
UCD..............................usual childhood
diseases
UGI ...............................upper gastrointestinal
U/O...............................urine output
URI ...............................upper respiratory
......................................infection
UROL ...........................urology/urological
UTI ...............................urinary tract
infection

A-1-9
V

VA.................................Veterans
Administration
VAB..............................Veterans
Administration
beneficiary
VAC..............................vacant beds
VAG (vag) ....................vagina
vaginal
VC.................................vital capacity
VD.................................venereal disease
VDRL............................Venereal Disease
Research
Laboratories

VFIB.............................ventricular
fibrillation
VMA.............................vanil mandelic acid
(vanillymandelic
a.)
VNA .............................Visiting Nurses
Association
VO................................verbal order
VS.................................vital signs
VSD..............................ventricular septal
defect
VSL...............................very seriously ill
list
VSS...............................vital signs stable

W

WBC.............................white blood count
WC................................wheelchair
WD................................ward
well-developed

WDWN.........................well-developed,
well-nourished
WNL .............................within normal
limits
wt..................................weight

X

X....................................multiplied by

Y

YO (y.o.).......................year old

A-1-10
APPENDIX 2

SYMBOLS

A-2-1
APPENDIX 3

TERMS USED IN CHARTING

Factor to be indicated: Suggested term to use:

Abdomen

1. hard, contracted rigid
2. soft, flabby relaxed
3. hurts when touched tender
4. filled with gas flatulent
5. enlarged, expanded distended

Administration of Medicine

1. by mouth orally
2. by rectum rectally
3. breathing in inhalation
4. rubbing into skin topically
5. under the skin subcutaneour
6. into the skin layers intradermal
7. into the muscle intramuscular
8. into the spine intraspinal, intrathecally
9. into the vein intravenous
10. pouring into a cavity instillation

Amounts (of Emesis, etc.)

1 large profuse, copious, large, excessive
2. medium obese
3. small acutely ill

Appearance, general

1. thin and undernourished amaciated
2. fat, greatly overweight obese
3. seems very sick acutely ill
4. not very sick not acutely ill

Appetite

1. eats all food served consumed 100% of diet (state type of diet)
2. eats very little consumed ___% of diet (state type of diet)
3. loss of appetite anorexia
4. refuses to eat refuses food (state reason)

A-3-1

Factor to be indicated Suggested term to use:

Areas

1. arm from shoulder to elbow upper arm, right or left
2. elbow to wrist lower are, right or left (forearm)
3. upper back interscapular region
4. small of back lumbar region
5. end of spine sacral region
6. gluteal area buttocks

Bleeding

1. in spurts in spurts
2. very little oozing
3. when stopped controlled
4. nosebleed epistaxis
5. blood in vomitus hematemesis
6. blood in urine hematuria
7. spitting up blood hemoptysis
8. blood in stool (dark) melena
9. blood in stool (bright rectal bleeding

Breathing

1. breathing respiration
2. inhale inspiration
3. exhale expiration
4. difficult breathing dyspnea
5. short quick breathing panting
6. noisy stertorous
7. absence of breathing apnea
8. only in sitting position orthopnea
9. period of apnea and dyspnea Cheyne-Stokes respiration

Breath

1. unpleasant halitosis
2. foul fetid
3. with sweet, fruit-like odor fruity

A-3-2

Factor to be indicated:

Cough

1. coughs all the time continuous cough
2. coughing over long period of persistent cough time
3. coughs up material productive cough (describe

Death

1. died expired

Defecation

1. bowel movement (material) feces, stool
2. bowel movement (act of) defecation
3. loose or watery defecation diarrhea
4. gray colored stool clay-colored stool
5. formed, yet soft stool soft-formed stool
6. formed, hardened feces hard-formed stool
7. thick, soft, black stool tarry stool
8. inability to pass stool constipation
9. constipated with large hard impacted stool

Drainage

1. watery, from nose coryza, nasal drainage
2. pus purulent
3. bloody sanguinous
4. feces fecal
5. lymphatic fluid serous
6. contains mucus and pus mucopurulent
7. tough, sticky tenacious
8. from vagina (after delivery) lochia

Dressing

1. a second dressing added to the dressing reinforced first

Emesis

1. ejected with force projectile
2. small amount of blood tinged blood is noticed
3. mostly blood hematemesis

A-3-3

Factor to be indicated: Suggested term to use:

Eyes

1. yellow colored jaundiced
2. puffy edematous
3. drooping eyelids ptosis of eyelids
4. sensitive to light photophobis
5. motionless fixed

Head

1. forehead frontal region
2. over temple temporal region
3. back of head occiptal region

Legs

1. hip to knee thigh, right or left
2. knee to ankle lower leg, right or left

Mental Attitude

1. hard to please irritable
2. distrustful suspicious
3. happy optimistic, cheerful
4. sad depressed
5. afraid apprehensive, anxious

NOTE: All statements on charts concerning attitudes must have
appears or apparently before them since they are the
interpretations of the observer. Only the patient knows for
sure what his or her attitude is. Give specific examples of
behavior to support observations.

Pain

1. comes in seizures paroxysmal
2. spreads to distant areas radiating
3. great severe
4. hurts worse when moved increased by movement
5. started all at once sudden onset
6. goes away with ... relieved by ...

A-3-4

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Hospital Corps School Table of Contents

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