THE DIFFERENCE BETWEEN PRIMARY, SECONDARY AND TERTIARY HEALTH CARE
At some point or other, you may have heard health professionals talk about primary, secondary or tertiary health care. These terms, which are used throughout the world, refer to levels of care, for cases ranging from mild to serious.
The primary care level is the “gatekeeper”, the first point of medical consultation. As a patient you are usually seen by a primary care physician, also called a general practitioner or family physician. Primary care is provided at a doctor’s office, health center or Urgent Care center. The Emergency Room is also often a source of primary care for the un- or under-insured.
According to the New England Healthcare Institute, demand for primary care continues to grow as patients become older and sicker. At the same time, there’s an increasing shortage of general practitioners. To meet the demand, physicians are starting to utilize nurse practitioners and physician assistants.
Medical specialists and other health professionals, who typically don’t have initial contact with patients, provide secondary care. For example, a primary care physician might refer a patient to a cardiologist, rheumatologist, or a urologist or other specialty physician. Some secondary care physicians do not require a patient to have a referral from a primary care practitioner.
Another category of secondary care is hospital care, or acute care. The term covers care as an admitted patient in a hospital, a visit to a hospital ER, attendance in childbirth, medical imaging (radiology) services and care within an intensive care unit.
Physical therapists, respiratory therapists, speech therapists, occupational therapists and other allied health professionals often work in secondary care.
Patients being treated requiring a higher level of care in a hospital may be considered to be in tertiary care. Physicians and equipment at this level are highly specialized. Tertiary care services include such areas as cardiac surgery, cancer treatment and management, burn treatment, plastic surgery, neurosurgery and other complicated treatments or procedures.
A fourth level of care, quaternary care, is a more complex level of tertiary care. Uncommon, highly specialized and experimental treatments and procedures are considered to be at the quaternary care level.
List of Services Offered by Hospitals
Hospital Services may be defined as facilities and utilities offered by hospitals in the form of medical and surgical assistance, laboratory and pharmaceutical provisions, staff and specialists, advanced equipment etc.
In short, hospital services include anything and everything that hospitals offer to their recipients. Most of these depend on the hospital’s motto, customer requirements and expectations.
Depending on the type of hospitals, the services they offer vary. However, every hospital needs to provide some core and mandatory services.
Listed below are some common and most required hospital services offered by every healthcare institute.
One of the distinguishing factors that marks hospitals unique, with respect to other health facilities; such as, clinics and care centers is that they provide both inpatient and outpatient care provisions.
Every hospital needs to have ward allotment for patients suffering from severe illness and injuries. This enables care givers to monitor health conditions continuously and thereby, accurate treatment procedures can be opted for.
In India, hospitals provide different types of wards for patients. Some of these are; general wards, private wards, semi private wards etc. Depending on choice and costs, patients can opt for any type of ward. Modern hospitals are sufficiently equipped to provide huge comfort to patients and are no less, or sometimes better than homes.
Nurses employed by hospitals function as connecting bridges between doctors and the patients they treat. Nurses look after the overall well being of patients. They ensure that all health related instructions given by doctors are implemented and followed by patients.
Nurses are employed in different departments within hospitals. Specialized hospitals hire trained nurses who are technically sound to perform advanced tasks relevant to diagnosis, treatment and care of sick ones.
Every hospital therefore has a separate nursing department which forms a core segment of hospitalization.
Out patient Department( OPD):
Every hospital needs to have an OPD (Outpatient Department) as one of the core services rendered. A set of skilled doctors along with technicians must be available, who can assist patients in preliminary diagnosis and related treatments.
Doctors prescribe medicines or diagnostic tests to evaluate a patient’s health condition. They are also required to be available for follow up visits to monitor conditions and treatment procedures. Depending on the response, patients are either asked for admission or specialized services such as surgeries.
Intensive Care Unit(ICU):
Almost every hospital in India provides ICU facilities for patients suffering from adverse health conditions. ICUs need to be equipped with modern technical apparatus and skilled professionals who can render best services. Depending on the type of hospital and services they focus on, there can be different types of ICUs. Some of them are, Neuro ICU, Coronary Care Unit, Neonatal ICU, Psychiatric ICU etc.
Pharmacy and Diagnosis:
Most hospitals in India do maintain a pharmacy and diagnostic department of their own. This is a very important segment as easy and quick availability of medicines and other equipment required for treatment procedure is vital to render best healing services.
However, many times, hospitals do not guarantee the availability of all medicines that are being prescribed and therefore independent pharmacies are equally important. Further, 9 out of 10 hospitals maintain a separate laboratory and diagnostic section where related tests can be carried out. Again, similar to pharmacies, these diagnostic departments do not offer a wide variety of tests and analysis for patients.
These were the five most common services related to hospitalization. The more advanced a hospital is in rendering services, the more popular and desirable it becomes. Indian hospitals are aiming at becoming more advanced in providing best and upgraded amenities to patients that can ultimately enhance their treatment procedures. Thus, with upgraded hospital features, the health care system in India will be at the top of providing best medical solutions to the entire population.
Different Departments Required in a Hospital
- 1. DEFINITION OF HOSPITAL According to WHO, “Hospital is an integral part of social medical organization, the functions of which is to provide complete health care for the population both, curative and preventive and who reach out to the family and its home environment. The hospital is also a center for training of health workers and for bio-social research.” Another definition was given by WHO in 1963 by the expert committee stating that : “Hospital is a residential establishment which provides short term and long term medical care consisting of observational, diagnostic, therapeutic and rehabilitative services for persons suffering or suspected to be suffering from a disease or injury and for parturient. It may or may not also provide services for inpatient or an outpatient basis.”
- 2. CASUALTY This department, also known as the accident and emergency department, deals with patients who have been brought in by an ambulance in an emergency situation. Sometimes patients find their own way to this department in case they have had an accident or seek immediate treatment. This department works 24/7 and is equipped to deal with all sorts of emergencies. The patients are assessed according to the degree of injury or emergency and then provided immediate treatment before being sent to a specialized department for further treatment. The Platt Report in 1962 gave birth to the official title of “Accident and Emergency Service”. This report stated the provisions that are to be followed for the smooth functioning of this department.
- 3. ANESTHETICS Doctors in this department administer anesthesia for patients for various procedures and surgeries. They provide the following services: Acute pain services post surgery Chronic pain services for patients suffering from bone related illnesses like arthritis Critical care services for those suffering from trauma Obstetrics anesthesia and analgesia like epidurals during childbirth and anesthesia for C-sections.
- 4. CARDIOLOGY The department as the name suggests deals with problems of the human heart or circulation. It treats people on an inpatient and outpatient basis. Some of their procedures include: Electrocardiogram (ECG) and exercise tests to measure the heart function Ultrasound scan of the heart ( Echocardiogram) Scans of the carotid artery in the neck to determine risks of stroke 24 hour blood pressure tests Insertion of pacemakers Coronary angiography to see if there are any blocks in the arteries Medical diagnosis and treatment of congenital heart defects, coronary artery disease, heart failure, valvular heart disease and electrophysiology Cardiac surgery
- 5. CRITICAL CARE This department also known as the Intensive Care Unit (ICU) provides treatment for seriously ill patients. Certain patients need to be isolated and require close and individual medical attention. The ICU has very few beds and is usually manned by specialist doctors and nurses as well as consultant anesthetists, physiotherapists and dieticians. Patients can be transferred from any department to the ICU in case the patient’s condition gets worse.
- 6. EARS, NOSE AND THROAT As the name suggests, this department deals with ailments concerned with the Ear, nose and throat and it includes treatment of a variety of ailments like: General ear, nose and throat diseases Neck lumps Cancers of the head and neck area Tear duct problems Facial skin lesions Balance and hearing disorders Snoring and sleep apnoea ENT allergy problems Salivary gland diseases Voice disorders ENT surgical procedures
- 7. GERIATRICS This department is usually manned with doctors specialized in geriatric medicine. Since the elderly suffer from a range of illnesses and seek treatment for: Stroke Gastroenterology Diabetes Locomotor problems Continence problems Syncope Bone disease This department also provides a range of community services like home visits, mobile therapy units, palliative care, and this department is often linked to other community centers.
- 8. GASTROENTEROLOGY This department deals with bowel related-medicine. It is usually run by specialist consultants and they investigate and treat upper and lower gastrointestinal diseases, as well as diseases of the pancreas and bile duct system. It also involves endoscopy and nutritional services. Some sub specialties include: Colorectal surgery Inflammatory bowel disease Swallowing problems Special nurses are often posted in this department and they are capable of performing a wide range of bowel investigations.
- 9. GENERAL SURGERY This department as the name suggests includes a wide variety of surgical procedures that include: Day surgery Thyroid surgery Kidney transplants Colon surgery Laparoscopic cholecystectomy (gallbladder removal) Endoscopy Breast surgery Day surgeries see a lot of patients coming in for minor surgeries such as hernia repairs, piles, … These procedures are normally performed by general surgeons and do not normally require special surgeons.
- 10. GYNECOLOGY This department deals with the investigation and treatment of problems of the female urinary tract and reproductive system. Infertility, incontinence and endometritis are some of the problems investigated in this department. Other services include cervical smear screen and post-menopausal bleeding checks. This department usually has a special ward, day surgery unit, an emergency gynecology assessment unit and outpatient clinics.
- 11. HEMATOLOGY This department can be part and parcel of the hospital laboratory or work closely with the hospital laboratory. Hematology includes the study of etiology, diagnosis, treatment, prognosis, and prevention of blood diseases that affect the production of blood and its components, such as blood cells, hemoglobin, blood proteins, and the mechanism of coagulation. The laboratory work that goes into the study of blood is frequently performed by a medical technologist. Hematologists also conduct studies in oncology—the medical treatment of cancer.
- 12. MATERNITY/NEONATAL/PEDIATRICS All facilities concerning giving birth and child care are provided in this department. In some hospitals these can be divided into three different departments but most general hospitals provide this care under one department itself. Some of the facilities or treatments include: Childbirth Midwifery Antenatal and postnatal care Pregnancy check ups Surgical procedures on children or mothers
- 13. NEUROLOGY Neurology deals with the human nervous system. The doctors in this department investigate and treat patients for problems that affect their brain and spinal cord. Surgical procedures on the brain and spinal cord are extremely dangerous and require highly qualified and experienced doctors and nurses to provide such special care. Neurologists examine patients who have been referred to them by other physicians in both the inpatient and outpatient settings. A neurologist will begin their interaction with a patient by taking a comprehensive medical history, and then perform a physical examination focusing on evaluating the nervous system. Components of the neurological examination include assessment of the patient’s cognitive function, cranial nerves, motor strength, sensation, reflexes, coordination, and gait.
- 14. ONCOLOGY This department investigates and treats all kinds of cancers and provides a wide range of chemotherapy treatments and radiotherapy for cancerous tumors and blood disorders. This department is usually linked to all the other departments as referrals can be made when one department cannot diagnose the patient’s problem. This department also requires highly qualified and experienced doctors and nurses. Doctors also carry out tumor removal procedures which are then sent for biopsy to confirm whether the tumor is malignant or not.
- 15. OPHTHALMOLOGY This department deals with the investigation and treatment of eye problems of adults and children. Their services include: General eye clinic appointments Laser treatments Optometry Orthoptics Prosthetic eye services Ophthalmic imaging.
- 16. ORTHOPEDICS This department deals with problems that affect the musculoskeletal system. That includes treating bones, muscles, tendons, ligaments, and nerves. Services include bone setting, surgeries to repair damaged bones or ligaments or tendons, replacing bones like hip replacement, knee cap replacement … Other outpatient services also include treating fractures and dislocated joints, musculoskeletal injuries and soft tissue injuries.
- 17. UROLOGY This department is usually a surgical department led by surgeons that perform certain specific services like: Flexible cystoscopy bladder checks Urodynamic research Prostate assessments and biopsies Shockwave lithotripsy to break up kidney stones.
- 18. PSYCHIATRY This department deals with investigating and treating patients with a wide range of mental illnesses and disorders. Some services include: Providing psychosocial counseling Investigating, diagnosing and treating psychiatric illnesses Conducting IQ tests De Addiction services.
- 19. OUTPATIENT In this department people come to the hospital only for a consult and not admission. The patients seek medical advice from a specific department depending on their problem and doctors provide a prescription of medication for them to take for a certain period of time. Patients are then asked to come back for a follow up. Patient’s treatment within the boundaries of the hospital lasts only a day. Outpatient department runs for a specific time during the day. Consultant doctors are usually brought in to handle OPD.
- 20. INPATIENT This department admits patients at least overnight for treatment. Here a case history of the patient will be taken and the patient will have a case sheet in which his progress will be recorded. Patients are monitored throughout the day by nurses and doctors come on rounds to check on the patients conditions. The duration of stay will depend on the severity of the patient’s illness.
- 21. CENTRAL STERILIZATION UNIT This department is in charge of keeping all the instruments used in the hospital clean and sterilized to avoid spreading of infections throughout the hospital. They follow a strict procedure for sterilizing medical and surgical instruments.
- 22. HOUSEKEEPING This department is in charge of keeping the hospital clean and neat. It involves doing the laundry and cleaning all the rooms of the hospital and effectively disposing of medical waste according to strict hospital disposal procedures.
- 23. CATERING AND FOOD SERVICES This department provides food services to inpatients, their families and staff of the hospital based on a nutritional menu provided by the Nutrition Department.
- 24. MEDICAL SOCIAL WORK This department manned with medical social workers help patients and their families deal with a broad range of psychosocial issues and stresses related to coping with illness and maintaining health. This department addresses the challenges families face, increases accessibility to healthcare, and serves as a bridge between the doctors and the individual, family, and community.
- 25. PHYSIOTHERAPY This department aims at rehabilitating patients. Mostly linked to the orthopedics department this department offers a wide range of body healing therapies that will help a patient resume normal functioning. This department offers outpatient as well as inpatient services.
- 26. PHARMACY Every hospital must be equipped with a pharmacy which provides drugs for the entire hospital. It not only provides medication for patients but also provides other drugs and instruments used by all the departments in the hospital for patient care or surgeries… Run by a pharmacist the pharmacy provides the following services: Purchase, supply and distribution of medication and pharmaceuticals Inpatient and outpatient dispensing Clinical and ward pharmacy Doctors are usually given a formulary of medication by the pharmacy to use as a guide.
- 27. NUTRITION AND DIETETICS This department is manned with specialists in nutrition and dietetics. They are assigned to provide professional advice on diet for hospital inpatient wards as well as outpatient departments. Certain departments require that the patient be put on a diet and therefore the team works with many other departments that treat: Diabetes Cancer Kidney problems Pediatrics Elderly care Surgery and critical care Gastroenterology These specialists can also suggest a dietary chart to be followed by the hospital canteen to ensure that all patients get nutritious food during their stay at the hospital.
- 28. MICROBIOLOGY This department deals with the microbial and viral aspects of medicine. This department is very important as the number of hospital-acquired infections is on the rise. These doctors usually carry out tests on samples from surgeries sent from various other departments and submit reports following biopsy.
- 29. DIAGNOSTIC IMAGING Also known as the department of radiology, this department provides the following services: General radiology (X-rays) Scans for Accidents and Emergency Mammography (breast scans) Ultrasound scans Angiography (x-ray of blood vessels) Interventional Radiology (minimal invasive procedures) CT scanning MRI scanning (3D scans using magnetic and radio waves) Patients are sent to this department for the above mentioned services as other departments do not have the required devices to perform diagnostic imaging. After the service is provided, reports will be given about the imaging and that report will have to be handed over to the department from which the imaging was requested.
- 30. MEDICAL RECORDS This department deals with recording, and maintaining all the records/files of inpatients as well as outpatients. It is with these records that medical statistics can be formulated and it serves as a reference for future purposes.
- 31. MEDICAL MAINTENANCE & ENGINEERING This department makes sure that the hospital is in operable condition. It makes plans and carries out various projects for the hospital. This department makes sure that all electrical facilities are in perfect condition, carries out repair and replacement work for air-conditioning units, plumbing, steel works, and generally takes care of the overall maintenance of the hospital.
- 32. INFORMATION TECHNOLOGY & COMMUNICATION All hospitals today use computers to keep track of patient records and other medically related affairs. Therefore this department is in charge of providing technical support as needed and keeping the systems updated and providing support when systems crash. They also aim to provide effective online services for patients and help to keep the entire hospital informed of certain events that take place within the hospital.
- 33. HUMAN RESOURCES This department is given the objective of recruiting efficient human resources for the hospital. It also has the duty of creating policies and procedures that the staff have to follow in the hospital. It aims at ensuring employee satisfaction, good working conditions and provision of monetary and non monetary benefits for the employees. It is also responsible for providing compensation for the services rendered by the employees.
- 34. FINANCE This department looks after the financial aspects of the hospital. They make budgets, financial plans for the future and allocate financial resources to the various departments of the hospital for their upgradation. They also provide wage statements for the staff and oversee purchases of medical supplies and pharmaceuticals for the hospital.
- 35. ADMINISTRATION This department is in charge of looking after the day to day operations of the hospital. They look after all the paperwork of the hospital and ensure that every department follows administrative procedures of the hospital.
Personal Care Assistant (PCA)
Provides health care tasks, personal hygiene services, housekeeping tasks and other related support services as outlined in a client’s Care Plan that are essential to the client’s health and safety needs.
1. Provide assistance in accomplishing activities of daily living(ADLs) which include the following: Dressing – Choosing appropriate clothing for the day, includes laying-out of clothing, actual applying and changing clothing, special appliances or wraps, transfers, mobility and positioning to complete this task. Grooming – Personal hygiene, includes basic hair care, oral care(including care of dentures), nail care (except recipients who are diabetic or have poor circulation), shaving , applying cosmetics and deodorant, care of eyeglasses, contact lenses, hearing aids. Bathing – Starting and finishing a bath or shower, transfers, mobility, positioning, using soap, rinsing, drying, inspecting skin and applying lotion. Eating – Getting food into the body, transfers, mobility, positioning, hand washing, applying of orthotics needed for eating, feeding, preparing meals and grocery shopping. Transfers – Moving from one seating/reclining area or position to another. Mobility – Moving including assistance with ambulation, including use of a wheelchair. Mobility does not include providing transportation for a recipient. Positioning – Including assistance with positioning or turning a recipient for necessary care and comfort. Toileting – Bowel/bladder elimination and care, transfers, mobility, positioning, feminine hygiene, use of toileting equipment or supplies, cleansing the perineal area and inspecting skin and adjusting clothing. Monitoring, assisting, offering direction and prompting activities that are integral to the cares listed above.
2. Provide assistance with health related procedures and tasks which includes: Passive/active range of motion or other exercises to maintain the optimal level of functioning. Respiratory Assistance: Application and maintenance of CPAP, BIPAP, respiratory vests, cough assist machines, and oxygen equipment Applying and maintaining prosthetics and orthotics Non-sterile catheter care Cleaning medical equipment Tube feedings Interventions for seizure disorders as instructed by the supervising RN. Special skin care Assistance with self-administered medication including bringing medication to the recipient, and assistance with opening medication under the direction of the client or responsible party CPAP
3. Providing redirection and intervention for behaviors: including observation and monitoring and documenting
4. Provide assistance in completing instrumental activities of daily living (IADLs) which includes but is not limited to: Meals- including planning and preparation, set-up, storing food, clean up and washing dishes Light housekeeping- including sweeping, mopping, dusting, vacuuming Laundry- including washing, drying, folding, and putting away laundry, changing linens, ironing clothes Basic assistance with paying bills Shopping for food, clothing and other essential items Accompanying to appointments Transportation- includes driving the client in client’s vehicle or accompanying on public transportation Recreation including but not limited to in-home and community activities
NOTE: IADLS are not a covered service for children under the age of 18 unless immediate attention is needed for health or hygiene reasons integral to the personal care services and the need is listed in the client’s Care Plan.
The Daily care need of patient
Nursing assistants are the primary caregiver to patients in most health care facilities. They are the people that patients see several times a day and come to rely on to fulfill simple requests that they could once handle themselves such as going to the bathroom, getting cold water for drinking and getting a snack to eat. Nursing assistants also provide comfort and companionship and are sometimes the most human interaction a patient has on a regular basis.
Whether you are a NA taking care of post-operative patients in a hospital or tending to terminal patients in hospice care, you will provide not only physical necessities and comfort – you will also provide emotional stability and support. Make no mistake, the nursing assistant plays a demanding but extremely rewarding role on the Health Care Team.
Patients, whether a young mother who has just given birth or an elderly gentlemen who is confined to a wheelchair, can feel a bit helpless when hospitalized. They often hesitate to communicate their needs accurately because they are intimidated. Their care is in the hands of medical professionals and they are in a vulnerable state, due to illness, general health or a recent change in their lives.
If a patient doesn’t speak up, do not assume his or her needs have been met. Always, always ask such questions as, “Is there anything I can get for you? Perhaps some fresh water?” or “Is your television working okay? Would you like me to change the channel for you?” This will give your patient the opportunity to respond with any concerns or desires he or she might have.
Communication is a two-way street — it is not only about talking, but also about listening. Patients can feel insignificant or unimportant when the nursing assistant breezes in several times a day, checks the vital signs and then breezes back out. Engaging in small talk and a few words of pleasant conversation are two easy things you can do to make your patients feel as though they matter.
Get to know the patients assigned to your care. There is no reason that visits to take vital signs, assist with bathing or other assignments can’t also be opportunities to interact on a friendly level. If there are photos of children or grandchildren displayed in the room, ask about them occasionally. If there are extra visitors coming on a particular day, congratulate them.
Keep in mind, however, that there are strict guidelines to personal communication with patients. While talking with them in order to get to know a bit about them is definitely beneficial to their sense of worth, telling them intimate details of your life is inappropriate. These are patients in your care, not marriage counsellors or siblings to confide in. You are there to help them, not the other way around. Above all, never talk about anyone else in the facility and never discuss other members of the Heath Care Team beyond their part in each patient’s care. Any breach of confidentiality of this type will jeopardize your career and can lead your patient to fear that he or she might be the topic of gossip when you are with others.
Comfort measures cover a broad range of functions that are, for the most part, common sense. As you go about your work each day, it is easy to take for granted the fact that you can walk, talk, move about freely and independently take care of your basic needs; this isn’t the case for many patients, especially in a nursing home or hospice environment.
A good rule of thumb is to take the time to inquire about each patient’s comfort and ask if there is anything they need each time you check their vital signs. A patient you dressed in the morning may be too warm by mid-day in the sweater you selected and may wish to change. Someone who is in a wheelchair may ask that the book they are reading be put within easy reach. As you get to know your patients, you should familiarize yourself with what makes them comfortable.
There are several things you should always be aware of in order to assure the comfort of your patients:
- Temperature tolerances. Some patients never feel warm enough. Remember to ask if they would like an additional blanket on cooler evenings. If they have a sweater, be sure to offer to help them into it or put it within reach so that they can easily don it when needed.
- Light tolerances. It is easy and quick to “throw open the blinds” every morning when you are waking patients for breakfast or their morning vital signs. Some patients find this alarming or upsetting. Think about it — would you like this every day? Be gentle when rousing them, and ask if they would like the curtains open, the overhead light or a bedside light on. Waking up slowly with gentle light may set the tone for the entire day for some of your patients.
- Clothing preferences. Your patients are individuals who have lost a great deal of their individuality and freedom by moving to a health care facility. One of the most personal statements a person makes is with his or her appearance — allow each patient who is capable to choose what he or she would like to wear each day. Although this may add an extra minute or two to the dressing routine, it will comfort them to be consulted about what they will wear that day. It will also encourage them to take pride in their appearance and hygiene.
- Food and Water. This sounds incredibly basic, but it can be forgotten when you have a busy schedule. Check to make sure all your patients have plenty of fresh ice water at all times. If they are permitted snacks (check with your charge nurse), see that these are available for them.
- Positioning. There is nothing more uncomfortable than being left to lie in bed in a position that puts pressure on your back or constricts movement of a leg or arm. Be attentive when you are placing someone in bed; ask him or her if they are comfortable and take the time to rearrange them until they are situated in a position that they are happy with. Just because you usually place them facing a window doesn’t mean that they want this every day — ask.
Understanding Your Patients
Understanding each patient as an individual is essential to proper care giving. Nursing assistants must remember that although they are working with individuals who may be ill, recovering or elderly, they are patients second. Each person must first be seen as an individual. Part of this process is coming to terms with situations that many may find surprising or uncomfortable.
Gender & Sexuality
As a nursing assistant you are expected to treat patients with dignity and disregard gender differences because, as a professional, you are not looking at them in a sexual sense. Remember, however, that a new patient may not yet be comfortable with this and feel extremely modest or embarrassed as you perform tasks such as assisting with bathing or the use of a bedpan. Do not ignore their discomfort or make too much of it. Simply reassure them and make an effort to maintain their dignity (for instance, by shielding as much of their body as you can to increase their sense of modesty and comfort level).
Sexuality is an area that is problematic — especially when working with geriatric patients. Society tells us that sexual expression is reserved for the young and healthy, but that isn’t at all the case — even those who are extremely advanced in age enjoy sexual activity, and those who are ill may find comfort in the closeness and affection of sharing a bed with a person dear to them.
Be aware of the rules and regulations of the facility you are working in regarding sexuality among patients, but focus on patients’ rights. In general, unless there is a health risk or one party is mentally incapable of making the decision, sexual activity should not be restricted between two adults even in a nursing home environment so long as discretion and privacy is maintained.
If a patient suffers from Alzheimer’s or Dementia, the situation becomes more complicated because of the loss of inhibition that is often exhibited in patients with these conditions. In a case like this, if a patient is exposing himself or masturbating in an inappropriate location — in the common area, for instance — he should be escorted back to his room rather than reprimanded in public. Humiliation does nothing to help the situation.
Cultural & Religious Differences
Do not assume that every patient you care for shares your particular beliefs. In many hospitals and other facilities, religious affiliation may be noted in patient records, which is a start. You should always respect the beliefs, or lack of belief, of each person you treat and not try to impose your own. At the holidays, if the facility decorates for Christmas, be sure to ask each patient before putting anything of a religious nature in their room — a Jewish or Muslim patient may be offended by the presence of Christmas ornaments in their living quarters.
As much as possible, allow each patient to express his or her religious beliefs and practice them openly. If they have brought religious icons or decorations from home, allowing them to display them in their room will make them feel more secure and at ease.
Recognize holidays particular to their religion with a good wish when you see them, and be respectful of any special requests for changes in their routine or diet. Do not interrupt a patient’s prayer or meditation for any reason unless it is an emergency. Schedule your rounds for vital signs, etc. around their usual worship practices.
1. A doctor will tell the MA which tests to perform on each patient. A MA follows protocols that explain in detail how each test is to be performed. Protocols are typically written by the doctor.
2. Medical assistants are also responsible for collecting samples for laboratory testing. They draw blood when the doctor orders blood work. Medical assistants process samples. They pack and ship samples to their appropriate destination.
Preparing patients is another duty performed by a MA.
- They get the patient ready for testing, treatment and procedures that the doctor may perform. Medical assistants expose any affected areas by removing bandages or clothing. When needed, they shave any necessary body parts.
- MA follow their protocols, which will explain in detail how and when to prepare the patient. For example, a MA will prepare a male cardiac patient for his EKG test by shaving areas in which the electrodes are placed to assure they stick properly to the skin. They would dry any moist skin where electrodes will be applied. The MA will apply the EKG electrodes, attach the lead wires and begin the test.
- Once the test is complete, the MA will print the collected data, remove the leads and electrodes from the patient and help the patient re-dress if assistance is necessary.
Patients and healthcare providers expect that surgical and invasive diagnostic or therapeutic procedures will not lead to infection. In the United States, there are more than 45 million surgical and invasive procedures performed annually, and lapses in infection control procedures may have devastating consequences producing patient morbidity or mortality. Based on estimates made by the Centers for Disease Control and Prevention (CDC), healthcare-associated infections (HAI) are one of the top 10 causes of death in the United States and produce a significant financial impact on the healthcare system.
Proper disinfection or sterilization of equipment is critical for preventing healthcare-related infection. The description of a recent outbreak of infection after thoracic surgery clearly illustrates the importance of adherence to accepted protocols. Seven patients having thoracic or cardiac anesthesia developed Pseudomonas aeruginosa pneumonia or bronchitis within several days after surgery. Investigation of several possible sources indicated that bronchoscopes used by anesthesiologists for placement of double lumen endotracheal tubes had not been properly disinfected after use. Inadequate cleaning of the used bronchoscopes and a problem with the automated equipment used for disinfection resulted in residual bacterial contamination of the bronchoscopes after processing. The pathogens remaining on the inadequately disinfected scopes were subsequently transmitted to several patients. Identification and correction of the flaws in the cleaning and disinfection processes terminated the outbreak.
The Spaulding Classification of Equipment for Disinfection and Sterilization
Infection control practitioners have used a classification scheme proposed by Earle Spaulding for determining appropriate disinfection and sterilization of patient care equipment. This approach has been generally accepted by the CDC and is contained in their most recent guidelines. Spaulding categorized devices as critical, semicritical, and noncritical corresponding to the risk of infection associated with its use. The greatest risk for infection is associated with contaminated critical items because these are devices that enter the patients’ sterile tissue or vascular system. Examples of critical devices include surgical instruments and vascular or urinary catheters. Semicritical items are those that contact mucous membranes or nonintact skin and include the majority of devices used in respiratory therapy and anesthesiology. Examples of semicritical items include the following: laryngoscope blades, esophageal stethoscopes, suction catheters, oral and nasal airways, and laryngeal mask airways. Noncritical items are devices that either do not touch the patient or contact only intact skin, but not mucous membranes and do not enter sterile tissues. Noncritical patient care items include devices such as blood pressure cuffs, pulse oximeter probes, and electrocardiogram (ECG) cables. Environmental surfaces can be considered noncritical items and include hospital beds and stretchers, the surface of the anesthesia machine, and laryngoscope handles. Since intact skin should provide an effective barrier to most pathogens, noncritical items are associated with a lower risk of infection, but they can serve as an environmental reservoir for pathogens. Because noncritical items are frequently touched by healthcare workers, secondary transmission of pathogens can occur to patients via contaminated hands or gloves.
A reduction in the number of microorganisms or their complete elimination from medical devices occurs along a spectrum, from cleaning through disinfection to sterilization. Cleaning is simply the physical removal of organic and inorganic material from devices and the surfaces of equipment. This can be accomplished by using water and detergents or enzymatic products to manually scrub and mechanically loosen the unwanted contaminating material. Cleaning may be used as a lower order process on noncritical items, but it is a mandatory step before disinfection or sterilization since the effectiveness of these higher order processes is compromised when residual inorganic or organic materials limit the active ingredients from contacting the device’s surfaces ( Figure 25–1 ). Decontamination is the process of removing pathogenic organisms from items before discarding or to make them safe to handle.
Laryngoscope blades for cleaning. Before disinfection or sterilization, equipment must be cleaned to remove blood, secretions, and other organic matter.
Disinfection can be used to eliminate most or all pathogenic microorganisms, except bacterial spores or prions, from medical devices. Disinfection occurs across a range, from low level to high ( Table 25–1 ). The level of disinfection is determined by several factors: the type and quantity of microbial contamination; the specific germicide, including its concentration and the exposure time; the physical nature of the object; the presence of a biofilm (a tightly adherent mass of bacteria and accumulated material); and the temperature and pH of the disinfection process ( Table 25–2 ). Low level disinfection processes kill most vegetative bacteria, some fungi, and some viruses. Intermediate level disinfection kills the previously mentioned groups and most viruses and mycobacteria. High level disinfectants will eliminate all microorganisms, except bacterial spores and prions. It is important to realize that disinfectants are chemicals and processes designed to kill microorganisms but are intended only for application to inanimate objects. Chemicals used as disinfectants must be evaluated and cleared for medical use by the U.S. Food and Drug Administration (FDA). In contrast, antiseptics are germicides that are intended for use on living tissue, mucous membranes, or skin, and these substances are regulated by the U.S. Environmental Protection Agency (EPA).
The Order of Resistance of Microorganisms and the Level of Disinfection or Sterilization Required for Inactivation
|Most Resistant||Required Level of Disinfection or Sterilization ∗|
|Prions (Creutzfeldt-Jakob disease)||Prion reprocessing|
|Bacterial spores (Bacillus atrophaeus)||Sterilization|
|Mycobacteria (M. tuberculosis)||High-level disinfection|
|Nonlipid or small viruses (polio, Coxsackie)||Intermediate-level disinfection|
|Fungi (Candida, Aspergillus)|
|Vegetative bacteria (S. aureus, P. aeruginosa)||Low-level disinfection|
|Lipid or medium-sized viruses (HIV, herpes, hepatitis B)|
∗ Level of disinfection or sterilization inactivates all microorganisms in the class and those classes listed below it.
Factors Affecting the Efficacy of Sterilization
|Cleaning||Failure to adequately clean an instrument results in higher bioburden, protein load, and salt concentration. These will decrease sterilization efficacy.|
|Bioburden||A larger number of microbes require a longer exposure to germicide for complete destruction. The natural bioburden of used surgical devices is 10 0 to 10 3 organisms (primarily vegetative bacteria), which is substantially below the 10 5 -10 6 spores used with biological indicators.|
|Pathogen type||Spore-forming organisms are most resistant to sterilization and are the test organisms required for FDA clearance. However, the contaminating microflora on used surgical instruments consists mainly of vegetative bacteria.|
|Protein||Residual protein decreases efficacy of sterilization. However, cleaning appears to rapidly remove protein load.|
|Salt||Residual salt decreases efficacy of sterilization more than protein load. However, cleaning appears to rapidly removal salt load.|
|Biofilm accumulation||Biofilm accumulation reduces efficacy of sterilization by impairing exposure of the sterilant to the microbial cell.|
|Lumen length||Increasing lumen length impairs sterilant penetration. May require forced flow through lumen to achieve sterilization.|
|Lumen diameter||Decreasing lumen diameter impairs sterilant penetration. May require forced flow through lumen to achieve sterilization.|
|Restricted flow||Sterilant must come into contact with microorganisms. Device designs that prevent or inhibit this contact (e.g., sharp bends, blind lumens) will decrease sterilization efficacy.|
|Device design and construction||Materials used in construction may affect compatibility with different sterilization processes and affect sterilization efficacy. Design issues (e.g., screws, hinges) will also affect sterilization efficacy.|
Modified from Table 10 in Rutala WA, Weber DJ, Healthcare Infection Control Practices Advisory Committee.
Sterilization is the process that eliminates all microorganisms and can be performed using either physical or chemical methods. Some chemicals commonly used for high-level disinfection can also produce sterilization under specific conditions ( Table 25–3 ).
Chemical Agents Used as Chemical Sterilants or as High-Level Disinfectants
|• Peracetic acid/hydrogen peroxide• Glutaraldehyde• Hydrogen peroxide• Ortho-phthalaldehyde• Peracetic acid|
|• Steam• Hydrogen peroxide gas plasma• 100% Ethylene oxide or ethylene oxide with hydrochlorofluorocarbon• Peracetic acid|
Disinfection of Healthcare Devices
With an understanding of the terminology of the Spaulding classification system, a matrix for appropriately processing medical equipment can be more easily understood. Critical items must be sterile and can either be purchased as sterile, single-patient use devices or may be reusable items that must be cleaned and sterilized between uses. Semicritical items must be sterile or require high-level disinfection. Most anesthesia airway equipment is considered semi critical and should undergo either high-level disinfection or sterilization. Because of the materials used and the difficulty sterilizing the long, narrow lumens, most bronchoscopes and endoscopes can only safely undergo high-level disinfection between patient use (see later discussion). Noncritical items should undergo cleaning or low level disinfection between patient use. This can be accomplished with disinfectant wipes to remove organic material including blood and secretions from external devices such as ECG cables and environmental surfaces (e.g., the work surfaces of anesthesia machines or drug carts) that may become soiled and are touched by healthcare providers.
Cleaning of equipment with detergents or enzymes is a critical part of the preparation process before disinfection or sterilization. Preferably, used items are soaked or rinsed before blood, tissue, or body substances dry on the instrument surface or in its channels ( Figure 25–1 ). Once secretions are dried, they become more difficult to remove. Although cleaning is often done by hand, there are several types of mechanical cleaning machines to automate the process.
Since they are made of materials that are stable during high temperatures, most surgical instruments undergo heat or steam sterilization. An increasing number of medical devices are made of less durable materials such as plastics and require low temperature sterilization. Traditionally, ethylene oxide gas sterilization has been used for heat-sensitive medical equipment, but more recently, many low temperature sterilization systems are available to sterilize devices that would be harmed by high temperatures. These low temperature sterilization techniques include the use of hydrogen peroxide gas plasma, peracetic acid immersion, and ozone.
The most widely used method for sterilization has been saturated steam under pressure in an autoclave ( Figure 25–2 ). Depending on the instrument being sterilized and the specific organisms that are to be eradicated, the autoclave processing cycle can be regulated by several parameters, including the amount of steam, pressure, temperature, and time. To confirm the effectiveness of the sterilization process, indicators are placed with the instruments in the autoclave.
Various routes of Drug Administration
Pharmacokinetics is the branch of pharmacology that deals with what happens to a drug when it is administered or ingested. The effects of a medicine or drug are influenced by the method that the drug enters the body, and often a given drug may be available in different forms or preparations.
There are five distinct methods for taking a medicine or drug. These methods are:
(1) Topical administration
(3) Oral administration
(5) Rectal administration
Topical administration refers to a drug that is applied on a surface, such as the skin. For example, Neosporin First Aid ointment is often applied to cuts or breaks in the skin to prevent infection.
Halothane is an example of a drug that is inhaled. This drug is a general anesthetic and because it is inhaled, it is rapidly distributed to the body, and it is very effective.
Many over-the-counter (OTC) and prescribed drugs come in a pill or liquid form. These drugs are taken orally, and are often the most convenient ways to administer a drug. Because these drugs enter the stomach, some are given a protective coating to prevent irritation in the lining of the stomach.
There are three ways to inject a drug: (1) intravenous (drug injected into a blood vessel), (2) intramuscular (drug injected into a muscle), and (3) subcutaneous (drug injected beneath the skin). There are a variety of reasons for using each of these methods, such as how quickly a drug’s effect is required or where a physician may want the drug to act (localized).
Finally, a drug may be in the form of a suppository and be administered rectally. While absorption of the drug through this method is not as reliable as oral administration, specific OTC drugs, such as Preparation H suppository, are very effective due to their actions at the desired local site.
Introduction to Human Body Structure & Function
Knowledge of the structure and the function of the human body are essential for those planning a career in the health sciences. It is the basis for understanding disease. In this unit, anatomy and physiology are defined, the body’s structural and functional organization is explained and an overview of the characteristics of life and homeostasis is provided. Finally, terminology and body plan are presented.
Anatomy is the scientific discipline that investigates the body’s structure. It describes the shape and size; it examines the relationship between the structures of the body parts and its function. The structure of a specific body part allows it to perform a particular function. Understanding the relationship between structure and function makes it easier to understand and appreciate Anatomy. Developmental anatomy is the study of the structural changes that occur between conception and adulthood. Embryology is a subspecialty of developmental anatomy that considers changes from conception to the end of 8th week of development. Cytology examines the structural features of cells and histology examines tissues, which are cells and the materials surrounding them. Gross anatomy is the study of structures that can be examined without the aid of a microscope. It can be approached from either a systemic or a regional perspective. In systemic anatomy, the body is studied system by system, which is the approach taken in most introductory textbooks. In regionally anatomy, the body is studied area by area. Within each region, such as the head, abdomen, or arm, all systems are studied simultaneously. Surface anatomy is the study of the external form of the body and its relation to deeper structures.
Physiology is the scientific investigation of the processes or functions of living things. The major goals of physiology are to understand and predict the body’s responses to stimuli and to understand how the body maintains conditions within a narrow range of values in a constantly changing environment. The study of the human body must encompass both anatomy and physiology because structures, functions, and processes are interlinked.
Human beings are arguably (questionably, perhaps) the most complex organisms on this planet. Imagine billions of microscopic parts, each with its own identity, working together in an organized manner for the benefit of the total being. The human body is a single structure but it is made up of billions of smaller structures organized at six levels: –
1. Chemical level: Involves interactions between atoms, which are tiny building blocks of matter.
2. Cell level: Cells are the basic structural and functional units of organisms. Atoms combine to form molecules. Molecules can combine to form organelles, such as the nucleus and mitochondria which make up cells. Cells has long been recognized as the simplest units of living matter that can maintain life and reproduce themselves.
3. Tissue level: Tissues are somewhat more complex units than cells. By definition, a tissue is an organization of a great many similar cells with varying amounts and kinds of nonliving, intercellular substance between them. The numerous different tissues that make up the body are classified into four basic types: epithelial, connective, muscle and nervous.
4. Organ level: Organs are more complex units than tissues. An organ is an organization of several different kinds of tissues (at least two types of tissues) arranged so that together they can perform a special function. For example, the stomach is an organization of muscle, connective, epithelial, and nervous tissues. Muscle and connective tissues form its wall, epithelial and connective tissues form its lining, and nervous tissue extends throughout both its wall and its lining. –
5. Organ system level: An organ system is a group of organs that have a common function or set of functions and are therefore viewed as a unit. e.g: urinary system (Kidneys, ureter, Urinary bladder and urethra). Eleven major organ systems compose the human body:
6. lymphatic system
11. Integumentary system (skin and accessories)
6.Organism level: An organism is any living thing considered as a whole whether composed of one cell, such as a bacterium, or of trillions of cells, such as human. The human organism is a complex organ system, all mutually dependent on one another.
1. Human Nervous System
The nervous system or the neural system is a complex network of neurons specialized to carry messages. The complexity of the nervous system increases as we move towards higher animals.
For instance, cnidarians such as jellyfish have relatively simple nerve nets spread throughout their body. Crabs have a more complicated nervous system in the form of 2 nerve centers called dorsal ganglion and ventral ganglion.
As we move further up the ladder, higher organisms such as vertebrates have a developed brain. Moreover, it is one of the most complicated structures in the animal kingdom, containing billions of neurons, all intricately connected.
In the human body, the neural system integrates the activities of organs based on the stimuli, which the neurons detect and transmit. They transmit messages in the form of electrical impulses and convey messages to and from the sense organs. Thus, the nervous coordination involves the participation of the sense organs, nerves, spinal cord, and brain.
One of the most complex organ system to ever evolve, the human nervous system consists of two parts, namely:
- Central Nervous System (consists of the brain and spinal cord)
- Peripheral Nervous System (includes all the nerves of the body)
1. Central Nervous System
There are 2 parts consist in C N S
What is the brain?
The brain is a complex organ that controls thought, memory, emotion, touch, motor skills, vision, breathing, temperature, hunger and every process that regulates our body. Together, the brain and spinal cord that extends from it make up the central nervous system, or CNS.
What is the brain made of?
Weighing about 3 pounds in the average adult, the brain is about 60% fat. The remaining 40% is a combination of water, protein, carbohydrates and salts. The brain itself is a not a muscle. It contains blood vessels and nerves, including neurons and glial cells.
What is the gray matter and white matter?
Gray and white matter are two different regions of the central nervous system. In the brain, gray matter refers to the darker, outer portion, while white matter describes the lighter, inner section underneath. In the spinal cord, this order is reversed: The white matter is on the outside, and the gray matter sits within.
Gray matter is primarily composed of neuron somas (the round central cell bodies), and white matter is mostly made of axons (the long stems that connects neurons together) wrapped in myelin (a protective coating). The different composition of neuron parts is why the two appear as separate shades on certain scans.
Each region serves a different role. Gray matter is primarily responsible for processing and interpreting information, while white matter transmits that information to other parts of the nervous system.
How does the brain work?
The brain sends and receives chemical and electrical signals throughout the body. Different signals control different processes, and your brain interprets each. Some make you feel tired, for example, while others make you feel pain.
Some messages are kept within the brain, while others are relayed through the spine and across the body’s vast network of nerves to distant extremities. To do this, the central nervous system relies on billions of neurons (nerve cells).
Main Parts of the Brain and Their Functions
At a high level, the brain can be divided into the cerebrum, brainstem and cerebellum.
The cerebrum (front of brain) comprises gray matter (the cerebral cortex) and white matter at its center. The largest part of the brain, the cerebrum initiates and coordinates movement and regulates temperature. Other areas of the cerebrum enable speech, judgment, thinking and reasoning, problem-solving, emotions and learning. Other functions relate to vision, hearing, touch and other senses.
Cortex is Latin for “bark,” and describes the outer gray matter covering of the cerebrum. The cortex has a large surface area due to its folds, and comprises about half of the brain’s weight.
The cerebral cortex is divided into two halves, or hemispheres. It is covered with ridges (gyri) and folds (sulci). The two halves join at a large, deep sulcus (the interhemispheric fissure, AKA the medial longitudinal fissure) that runs from the front of the head to the back. The right hemisphere controls the left side of the body, and the left half controls the right side of the body. The two halves communicate with one another through a large, C-shaped structure of white matter and nerve pathways called the corpus callosum. The corpus callosum is in the center of the cerebrum.
The brainstem (middle of brain) connects the cerebrum with the spinal cord. The brainstem includes the midbrain, the pons and the medulla.
- Midbrain. The midbrain (or mesencephalon) is a very complex structure with a range of different neuron clusters (nuclei and colliculi), neural pathways and other structures. These features facilitate various functions, from hearing and movement to calculating responses and environmental changes. The midbrain also contains the substantia nigra, an area affected by Parkinson’s disease that is rich in dopamine neurons and part of the basal ganglia, which enables movement and coordination.
- Pons. The pons is the origin for four of the 12 cranial nerves, which enable a range of activities such as tear production, chewing, blinking, focusing vision, balance, hearing and facial expression. Named for the Latin word for “bridge,” the pons is the connection between the midbrain and the medulla.
- Medulla. At the bottom of the brainstem, the medulla is where the brain meets the spinal cord. The medulla is essential to survival. Functions of the medulla regulate many bodily activities, including heart rhythm, breathing, blood flow, and oxygen and carbon dioxide levels. The medulla produces reflexive activities such as sneezing, vomiting, coughing and swallowing.
The spinal cord extends from the bottom of the medulla and through a large opening in the bottom of the skull. Supported by the vertebrae, the spinal cord carries messages to and from the brain and the rest of the body.
The cerebellum (“little brain”) is a fist-sized portion of the brain located at the back of the head, below the temporal and occipital lobes and above the brainstem. Like the cerebral cortex, it has two hemispheres. The outer portion contains neurons, and the inner area communicates with the cerebral cortex. Its function is to coordinate voluntary muscle movements and to maintain posture, balance and equilibrium. New studies are exploring the cerebellum’s roles in thought, emotions and social behavior, as well as its possible involvement in addiction, autism and schizophrenia.