communication skills for physician assistant

Certified Chiropractic Physician’s Assistant, 4th Edition

2011 Copyright, Chiropractic Educational Network 140

Chapter 10

Communication Skills



Section 10-1

What is Communication?

Communications:

Why do we communicate?

Psychological function:

We communicate to meet needs

We communicate to enhance our sense of self

Social Function:

1. We communicate to develop relationships

A:

B:

2. We Communicate to fulfill social obligations

Decision Making:

1. To exchange information

2. To influence others



Health Care:

1. To educate patients

2. To provide quality care

3. To ensure patient safety

4. To make health care in our office exceptional

Without great communication skills, your office will suffer from poor communication

to the patient and between staff

What is communication?

What is competent Communication?

Being able to send, receive and interpret information through verbal or non-verbal

communication

The ability to communicate in a personally effective and socially appropriate manner

Elements of competence:

1. Knowledge

What do you know about the subject you’re discussing?

What does the person(s) you’re communicating to know about the subject your

discussing?



2. Skills

Communication skills are best learned through personal experiences

3. Commitment

Great communication skills take hard work and determination to be effective

4. Sensitivity

Questions for thought:

Does competent communication ever necessitate dishonesty?

1. Communication is a process

2. Communication is sharing meaning

3. Effectiveness

4. Expressing feelings and emotions




Do you feel health care office workers have become very "ME" oriented instead of

patient oriented?

There are two key elements used to communicate each time you speak:

#1 Verbal Communications: Verbal is the message itself

#2 Visual & Non-Verbal

Practicing Non-Verbal

Interpreting Facial Expressions:




Do you think a doctor or office manager faced with negative and inefficient workers uses

controlling, not problem solving strategies?

Effective communication is mostly

A: verbal-what/words you say?

B: Vocal- how you say it

C:Visual-what you see

List what percent you think is correct?

Verbal ________ %

Vocal ________ %

Visual ________ %

Correct % is:

Verbal ________ %

Vocal ________ %

Visual ________ %



Section 10-2

Behavioral skills

1. Eye communication

2. Body language

3. Facial expressions

4. Appearance

Do you judge people by how they look?

Do people judge your appearance?

If you dress poorly does that mean you’re a bad communicator?

If you dress great does that mean you’re a great communicator?



5. Non-verbal

Use them to put emphasis on your communication

Be careful that others watch you

Try not to convey the wrong communication by using bad body language

6. Voice clarity

7. Listener attentiveness

8. Believability


Do you think the doctor or office manager should argue or discuss office problems when

patients are within hearing range?



How to talk to the doctor:

How does communication affect your effectiveness in health care?

1. Conveys your educational level

Poor communication tells patients you’re not too smart

2. Conveys your experience

Patients will know that the better you communicate the more experiences you are

3. Determines if YOU communicate the correct message

What you must communicate the patient?

1. What you need them to do

2. How you need them to do it



3. What they will experience

4. They need to pay for treatment

5. They must follow the doctor’s orders

6. How important HEALTH is to their life

Communicating Bad News to a patient!

It is very stressful to communicate bad news to someone. It requires tactfulness,

respect and excellent communication skills.

How you can help

How they must be positive

That sometimes you must address the bad to find the good

How will a patient respond to bad news?

1. Accept-

2. Reject-

3. Question-

4. Argue-



Psychological Barriers of communication:


Should group members learn to become assertive versus aggressive?



Section 10-3

How we learn to communicate

Infancy:

Sounds heard

Learning response to sound

Responding to touch

That when we cry they react

Early Childhood:

Trying things (curiosity)

Learning from mistakes

Persistent trying

Observing others

Adult:

Learn from others

Experience life

Get better as we go

Observation

Communication factors:

1. Culture

May dictate values

Keeps some people primitive

May vary from others

2. Education

Formal education instills basics

Allows you to understand the rules of communication

Provides guidelines

3. Word Choice

Never use bad words

Try not to be too technical

Choice the appropriate word

Avoid using slang words



4. Grammar

Is important

Shows your knowledge

Makes you look bad if not used correctly

5. Personal or Professional use

Divide the personal and profession conversation

Never burden patients with your problems

Don’t take business communications personal

6. Life Experience

Make you a better communicator

Teach you what to avoid saying

Builds your vocabulary

7. Social Influence

You learn word socially acceptable

You learn bad words

Bad language not socially acceptable

Your sometimes pressured to use key words

8. Negative Influence

If you always talk to poor communicators you learn bad habits

You can negatively influence others with your words

Slang words are negative

The tone of your communication can convey negative

Sending the message

The correct way



Problems that occur

Receiving the message

The correct way

Problems that occur

Interpretation of a message

The correct way

Problems that occur

Responding to a message

The correct way



Problems that occur

Listening

The correct way

Problems that occur

Understanding patient communication- Are you listening to the patient?

Are you listening to the patient? They are telling you every complaint and concern which

ultimately leads to a diagnosis. Why are today’s health care workers suddenly becoming highly

insensitive to the relevance of great communications?

If each patient in your office was surveyed, how many of them would say, "My doctor doesn't

listen to me"? Did you know on average, doctors interrupt patients only 18 seconds after they

begin to speak? This results from the doctors taking the discussion towards technical terminology

which deprives many patients of the chance to tell their whole story. If the doctor or health care

team interrupts the patient you will miss important information including the important

psychosocial factors.



What is the "Failure Zone"?



Skills for effective communication with patients

1. Plan the visit with the patient

2. Create rapport quickly

3. Draw out a patient's concerns

4. Ask the patient's perspective

5. Demonstrate empathy

6. Be open to the patient's emotions

7. Be aware of your own reactions

8. Invest in the end (a wellness patient)

9. Provide education

10. Involve the patient in making decision



Section 10-4

Listening Skills

Ask a friend or co-worker if they are a good listener and usually they'll say yes. And they'll say

it's easy to be a good listener. However, in health care one reason for errors and internal

communication breakdowns result from poor listening skills.

Being a great communicator does not mean getting others to do what you want them to do. In

general good listening means just that, you listen! Don’t forget the basic truth about being a

good listener:

Listening is a two-way process

o Yes, you need to be heard

You also need to hear the other person's ideas, questions and objections

o If you talk at someone instead of listening you defeat your goal

In a chiropractic office, chiropractic assistants who are good listeners steer conversations

towards the patient’s interests. Further, you will not learn anything about the patient or their

condition when you are doing all the talking. Being a good listener also means paying close

attention to details relative to the communication. For example, if a patient comes in and you

dominate the conversation several things will happen.

1. They feel their concerns are not important to you

2. They will not open up to you and fully disclose all the details you need about their

health history and things related to their current condition

3. It creates a psychological barrier

It will take practice, determination and persistence to be a good listener. In the end your efforts

will provide you with a wonderful tool in your career. You will find that being a good listener

is just one step to becoming a better communicator.

The art of effective listening includes receiving a message and providing decisive feedback. The

process should be very interactive. It involves hearing, decoding what you hear, evaluation of

the verbal message and focus on details of what you hear.



To be a better communicator practices the following:

Listen and let the person finish before you respond

Listen , decode the message and respond

Focus on nonverbal behavior

Defuse emotional situations by maintaining professionals communications

Ways to listen better to patients

1. Let the patient talk without interruption

2. Expand on hints the patient drops

3. Show you are listening

4. Be reflective

5. Determine patient's expectations for treatment

6. Maintain eye contact

Keys to convey positive nonverbal messages

Acknowledge the patient immediately

o Greet and comfort first, do paper work second

o Don't let patients wait, even if you are busy

o Show that you will assist them shortly and let them know you are aware of their

presence

Give your full attention to those patients who are present.

o If you must answer the phone, do not hesitate to put the patient on the phone

on hold while you address the patient in your immediate presence.

o If you are talking with another staff member, excuse yourself immediately and

address the patient. All staff must recognize that the patient comes first.

o End all personal conversations on the telephone immediately upon the approach

of a patient.

Introduce yourself

o You, too, are a person with an identity to which the patient can relate

o Give the patient your first name and describe in simple terms what you will be

doing

o Reinforce the spoken use of your name with a visible name tag, a name plate on

your desk



Give the patient your full attention

o Staff members should not interrupt when you are with a patient except in

emergencies

Use appropriate language

o Use language the patient will understand

o Don't talk about irrelevant subjects

Use the time to explain procedures and routine tasks

Be discreet

o Respect the patient's privacy

o Be competent and knowledgeable

Communication Barriers

The message gets altered through interference:

Not Listening:

Causes for not listening:

1. Topic is boring

2. Distracted by other interests

3. In a hurry

4. Don’t like the person

5. Tired



How to be a better listener?

1. Respect them

2. Take time to listen

3. Take time to focus

4. Know it’s important

5. Practice



Chapter 9 Review

Critical Thinking

1. Write about a communication experience you have had with a patient that was difficult.

Discuss the situation and how you handled it?

2. Write ½ page about how culture can influence a person ability to communicate?

3. List your top 3 trouble areas with communication?

In Review

1. What is the definition of communication?

2. Why do we communicate?

3. How does your ability to communicate affect patient care?



Chapter 11

Nutrition & Wellness



Section 11-1

Vitamins

Nutrition

What is Nutrition? Eating all fruits and vegetables, having a non-fat diet?

Write down what YOU think nutrition is:

An incredible interest has peaked in society as we are taught more about the multitude of

important functions those vitamins, mineral and herbs to assist the bodies performance. The

attitude towards vitamin and nutritional supplement use is changing as people learn more about

the benefits.

New studies show that vitamins protect us, not only from deficiency disorders, they may also

slow the aging process, and lesson the healing time of illness. There is no doubt that vitamins

and minerals are important to good health. Researchers are learning more and more about

how theses nutrient are absorbed and used in the body in ways that may prevent degenerate

disease, enhance the immune system and slow the aging process in whole.

What are vitamins?

Organic (carbon containing) substances derived from plants and animals. They are called

micronutrients because they are needed in relatively small amounts in the body when compared

to macronutrients such as carbohydrates, fats, and proteins that make up most of the diet and

provide energy.

History of the Vitamin:

o The first vitamin was called Vitamine “A” by scientist in 1913. But the E at the end of the

word was eventually dropped.

o All vitamins are either water-soluble or fat-soluble.

Fat-soluble vitamins are:

A, D, E & K

These vitamins dissolve in liquid fats not in water.



These vitamins are absorbed through the intestinal tract with the assistance of bile

acids and dietary fats and stored in the body.

These vitamins can become toxic if consumed in extremely high doses.

Water-soluble vitamins are:

C

B COMPLETE

Water-soluble are absorbed through the gastrointestinal tract without the help of dietary fats

and bile acids.

Mineral Basics:

Minerals are inorganic substances

Minerals can work as co-enzymes helping enzymes to active the body’s biochemical

processes.

Common minerals include:

Calcium-Is important for the cells of the body, bone development and the nerves

throughout the body

Iodine-This is a very essential mineral which most people gain by using iodized salt on

their food

Iron-Less than a quarter ounce of iron is present in the entire body, yet iron is found

in every red blood cell. Without iron the body could not survive as there would be no

hemoglobin.

Antioxidants:

Antioxidants protect the body against highly reactive molecules known as free radicals.

Uncontrolled these harmful molecules wreak havoc on a healthy cells and tissues, leading the

development of degenerative disease.



Knowing your Vitamins

Vitamin A:

Helps prevent night blindness

Reduces the risk of eye problems

Helps to promote a healthy immune system

Protect cells against cardiovascular disease

Vitamins A found in the following foods:

Egg yolks

Cod liver oil

Milk

Cheese

Butter

Ice-cream

Fish

Fish Oils

Organ meat(i.e. liver)

How to determine if you are at risk for vitamin “A” deficiency:

Do you have chronic liver disease?

Do you have chronic diarrhea

Do you take cholesterol lowering medication?

Do you take oral contraceptives?

Do you drink large amounts of alcohol?

Are you under great emotional stress?

Are you pregnant or breast-feeding?



Vitamin D:

Vitamin D is an essential nutrient for maintaining bone density. The body needs vitamin D

which allows calcium to build the bones. Vitamins D enhance the adsorption of bone-building

minerals, such as calcium and phosphorus.

How to determine if you are at risk for vitamin “D” deficiency:

Do you spend most of your time indoor, secluded from sunlight?

Do you have Kidney or Liver disease?

Do you take anticonvulsant medications?

Do you use mineral laxatives?

Do you drink large amount of alcohol?

Are you an older person?

Vitamin D found in the following foods:

Eggs

Butter

Oily fish (i.e. salmon, sardines)

Liver

Cod Liver oil

**Green leafy vegetables only contain a small fraction of vitamin D.

Vitamin E:

Vitamins E are an antioxidant that protects cells against the effects of oxidation.

Vitamins E found in the following foods:

Vegetable oils

Sunflowers

Soybean

Corn

Wheat Germ

Cotton seed oils

Sweet Potato

Nuts



How to determine if you are at risk for vitamin “E” deficiency:

Do you take cholesterol lower medications?

Do you use mineral oil laxatives?

Do you smoke cigarettes?

Are you exposed to environmental pollution?

Vitamin K:

Vitamin K is the least known of all vitamins. Vitamins K are involved with helping the clotting

of blood and bone formation. Vitamins K deficiencies are rare because it is found in such a

wide variety of foods.

Vitamins K found in the following foods:

Spinach/Greens

Turnips/Cabbage

Cereals

Fruits

How to determine if you are at risk for vitamin “K” deficiency:

Do you have Crohn’s Disease?

Do you take cholesterol lower medications?

Do you use mineral oil laxatives?

Are you taking antibiotics?

Vitamin B:

This is an important for enhanced energy production in the body. It is essential for body

growth and the repair of all body tissues.



Vitamin B found in the following foods:

Milk and Dairy product

Green vegetables

Avocados

Cereal with whole grain

How to determine if you are at risk for vitamin “B” deficiency:

Do you have diabetes?

Do you take diuretics (Water pills)?

Do you take antidepressants?

Do you exercise regularly?

Vitamin C:

Is essential in the formation and maintenance of collagen, a protein that is a chief component of

the body’s connective tissues, including cartilage, bone, teeth, skin, ligaments, and tendons.

Vitamins C found in the following foods:

Broccoli

Brussels Sprouts

Turnip greens

Sweet Peppers

Parsley

Strawberries

Cabbage

Cauliflower

Grapefruit

Citrus fruits

Lima beans

Melons

How to determine if you are at risk for vitamin “C” deficiency:

Do you have Diabetes?

Do you take Aspirin or Tetracycline?

Do you use oral contraceptives?



What is the relevance between diet and nutrition and Health?

Malnutrition depresses the ability of the body’s immune system.

The role of nutrition is maintaining adequate immune function, especially in the elderly.

A balanced diet and increasingly strong immune system promotes longevity.

Keeping a constant level of adequate nutrition reduces the changes of loss of health.

Keeping your body full of the correct nutrients promotes a strong and healthy

musculoskeletal system.

Proper nutrition allows you to have more energy.



Section 10-2

Diet

Why people diet?

Types of diet supplements

How does supplemental diet treatment affect the body?

Most common types simply expand the stomach so you feel full

Other speed up metabolism to HURRY food through the body

Improper diet techniques:

Skipping meals

Taking stimulants

Not under doctor supervision

Correct Diet Techniques:

Consult with your doctor first

Diet must include regular meals

Incorporate exercise

Limit fat intake



Your diet determines your need for supplements:

Answer the following yes or no:

_____ Do you tend to skip meals?

_____ Do you eat fewer than 3 servings of fruits/vegetable per day?

_____ Do you have variety in your diet?

_____ Do you avoid whole grain, dairy, fish, etc.?

_____ Smoke?

_____ Drink alcohol daily/weekly?

_____ I don’t drink milk?

_____ I have a poor appetite?

_____ I don’t take time cook balanced meals?

_____ I am always dieting?

You are what you eat

Why do some people eat more than others?



Section 11-3

Foods the body needs

What types of foods does the body need?

In many ways, our bodies can be thought of as chemical processing plants. Chemicals are taken

in, processed through various types of reactions and then distributed throughout the body to be

used immediately or stored for later use.

The chemicals that are used by the body can be divided into two broad categories:

Macronutrients

o those substances that we need to eat regularly in fairly large quantities

Micronutrients

o those substances that we need only in small amounts

Carbohydrates:

Carbohydrates are the sugar and starchy foods that most of people crave daily. Most

carbohydrates are found naturally in the form in which food is stored by plants and not found

in animal products. They are mostly found in fruits and vegetables which are for the most part

good for the body.

Carbohydrates are the main energy source for the human body. Chemically, carbohydrates are

organic molecules in which carbon, hydrogen and oxygen bond together in the ratio: The body

breaks down carbohydrates during the process of metabolism to release energy.

We obtain carbohydrates by eating foods that contain them, for example potatoes, rice, breads,

etc. These carbohydrates are manufactured by plants during the process of photosynthesis.

Plants harvest energy from sunlight to run the reaction described above in reverse.

Carbohydrate facts:

Too many carbohydrates may be bad for the body as sugar or starch consumed in excess

will convert to fat after your body does not need any more of it.

Carbohydrates are needed as they provide quick energy for the body and for most

people are easily accessible and inexpensive.



All carbohydrates are broken down during digestion and changed into a simple sugar

called glucose. Glucose is absorbed into the blood in this form where it changes to a

substance called glycogen.

Glycogen can be used by the body later as it is stored in the liver and muscle tissue.

Carbohydrates come in two basic forms: complex and simple.

Simple carbs are one, two, or at most three units of sugar linked together in single

molecules.

Complex carbs are hundreds or thousands of sugar units linked together in single

molecules. Simple sugars are easily identified by their taste: sweet. Complex carbs, such as

potatoes, are pleasant to the taste buds, but not sweet.

The Result of Excess Carbohydrate Intake

Excess carbohydrates also cause generalized vascular disease. The high-carbohydrate diet

which is now so popular causes the pancreas to produce large amounts of insulin, and if

this happens for many years in a genetically predisposed person, the insulin receptors

throughout the body become resistant to insulin. Because insulin's action is to drive

glucose into the cells, this results in chronic hyperglycemia, also called "high blood sugar."

A large portion of this sugar is stored as fat resulting in obesity. Excess insulin also causes

hypertension and helps initiate the sequence of events in the arterial wall which leads to

atherosclerosis and heart disease.

Excess fats damage the immune system through irradiation by free radical cells.

Fats:

Fats are a sub-group of compounds known as lipids that are found in the body and have

the general property of being hydrophobic (meaning they are insoluble in water).

The main purpose of fats in the body is to serve as a storage system and reserve supply of

energy. During periods of low food consumption, fat reserves in the body can be

mobilized and broken down to release energy.

Fats serve as an insulation material to allow body heat to be conserved and fats line and

protect delicate internal organs from physical damage.



Fats in the diet can be converted to other lipids that serve as the main structural material

in the membranes surrounding our cells.

Fats can be classified as either saturated or unsaturated:

The consumption of saturated fats carries some health risks in that they have been linked

to arteriosclerosis (hardening of the arteries) and heart disease.

Unsaturated fats can be either polyunsaturated (many double bonds) or

monounsaturated fats (one or few double bonds). Recent research suggests that the

healthiest of the fats in the human diet are the monounsaturated fats, such as olive oil

and canola oil, because they appear to be beneficial in the fight against heart disease

Protein:

The most important type of food is protein. It supplies not only food to the body but works to

repair damaged and create new tissues in the body. Every cell of the body is made up of protein

and required continuous supplies to keep cells alive.

Can a high protein diet can be effective for someone trying to lose weight and lose fat? Well

some studies say yes. Most high protein foods are extremely low in carbs and extremely low in

saturated fat (which is the fat that you DON'T want to eat). Therefore, by eating a high protein

diet loaded with high protein foods, at the same time you'd end up eating low carb foods and

low saturated fat foods. And, if you didn't already know, in order to lose weight and lose fat,

eating low carbs and eating little or no saturated fat is a MUST.

Some high protein foods are:

Chicken

Turkey

Lean meats and beef

Fish (just about every fish is high in protein, anything from tuna fish, to salmon, to

shrimp)

Egg whites

If you decide on a high protein diet, the most important times to eat high protein foods are:

First thing in the morning after you wake up

Last thing at night before you go to bed

Directly after your workout.



However, remember that the main point of eating a high protein diet is to give your body the

protein it needs all day long, which is why it would be a good idea to eat a meal once every 3

hours or so this way your body will always have what it needs.

Note: carbohydrates, proteins and fats are all macronutrients

Vitamins:

1. Can be obtained by foods consumed

2. Others are human made and taken as supplemental

3. Are necessary to assist the body to function

Minerals:

Are found in foods we eat

Note: Vitamins and minerals are micronutrients

Water:

Water is a vital nutrient



Section 11-5

Nutritional Guidelines

RDA = Recommended Daily Allowance

3 components of food choice include:

1. Proportion

2. Variety

3. Moderation

Fiber:

We live in a highly toxic world, where what we eat and drink plays a more critical role in our

health than ever before. Not only is our food poisoned with thousands of chemicals but also

virtually devoid of any nutrients. We try to compensate for this lack by eating much larger

quantities than would otherwise be necessary. To make things worse, most of us don’t engage

in regular physical activity.

Role of fiber in the body functions:

Binds toxic chemicals preventing their absorption

Binds bile acids lowering serum cholesterol levels

Increases bulk and softness of feces, reducing pressure on colon walls

Decreases transit time of feces

List your eating habits from yesterday:

Breakfast:

Lunch:

Dinner:



Planning a healthy diet includes many factors such as:

1. How often should you eat?

Only when you are hungry

When your body needs fuel

2. How much should you eat?

Eat your food slowly

Never stack your plate

If you feel very hungry, let the larger portions be fruits and vegetables

3. Nutritional supplements:

Increase metabolism

Help with digestions

Assist with nutrient absorption

The difference between diet and nutritional supplements:

Diet supplements help with losing weight

Nutritional supplement help boost the body’s ability to absorb foods or replaces lost

nutrients such as calcium

Why are vegetables important?

Vegetables provide vitamins, such as vitamins A and C, and folate, and minerals, such

as iron and magnesium. They are naturally low in fat and also provide fiber. The

Food Guide Pyramid suggests 3 to 5 servings of these foods a day.

Why are fruits important?

Fruit and fruit juices provide important amounts of vitamins A and C and potassium. They are

low in fat and sodium.

Section 11-5

Cholesterol



Cholesterol is a fat like substance that is normally present in the blood. Most of the cholesterol

is manufactured in the body, mainly the liver. The rest comes from foods we eat.

Understanding Cholesterol

1. Cholesterol is a paradox: Everyone needs it, but too much of this good thing can spell

trouble for some people.

2. A fat-like substance, cholesterol aids vital bodily functions such as building new cells,

producing hormones, and digestion.

3. Normally, your liver makes all the cholesterol your body needs. But you also get cholesterol

from your diet. Cholesterol is found in foods derived from animal products, although it's

possible to remove it through special processing techniques. While foods derived from plant

products do not contain cholesterol, they can (like animal products) contain saturated fats.

And a diet high in saturated fats can also raise your cholesterol level, especially if you are

genetically predisposed to high cholesterol.

4. The cholesterol and fats you eat are absorbed into your blood through your stomach and

intestines. Much of the fat is then transported to fat cells, while most of the cholesterol is

taken to wherever your body needs it in the form of high density lipoprotein (HDL)

particles. Your liver takes up whatever is left. This leftover cholesterol is either used by the

body or taken apart to create low density lipoprotein (LDL) which circulates in your blood.

5. LDL cholesterol collects in the walls of arteries, initiating hardening of the arteries.

6. Since no one can predict with certainty which people with high cholesterol will develop

heart disease, play it safe and keep your cholesterol levels in check. The American Heart

Association recommends that you eat less than 300 mg of cholesterol per day.

Who Develops Cholesterol Problems?

Some families are genetically blessed with low total cholesterol or high levels of HDL (“good

cholesterol”), regardless of diet or lifestyle. Other families inherit genes that increase their risk

for high cholesterol. In these people, eating a diet high in saturated fat can significantly raise

cholesterol levels. Stress can also raise blood cholesterol levels, especially since stress can lead to

poor eating habits that may increase cholesterol intake.

How high is too high?

Desirable Less than 200



Borderline 200-239

High 240 and above

The best way to monitor your cholesterol is have it check yearly.

Risk factors of High Cholesterol?

Obesity

Smoking

History of heart disease

Not exercising

Bad Cholesterol (LDL):

Low Density Lipo Proteins

LDL - The "BAD" cholesterol

LDL is the most numerous cholesterol carrier found in the blood. It is also the material

that contributes most to the buildup of plaque on artery walls.

Decreasing the amount of LDL cholesterol in the blood is an important part of decreasing

risk of heart disease.

How Medical doctors attempt to lower cholesterol:

Chiropractors try changes in diet and exercise

Medical doctor initial drugs such as lipitor

Cholesterol lowering medications have severe side effects

Natural ways to lower bad cholesterol:

Changes in diet

Increasing or initiating a regular exercise program

Good Cholesterol (HDL):

High Density Lipoprotein’s



HDL - The "GOOD" cholesterol

HDL cholesterol makes up a smaller portion of the cholesterol carriers.

HDL removes cholesterol from the blood by carrying it to the liver where it is

metabolized. Therefore, it is beneficial to have high levels of HDL in the blood.

Triglycerides:

Triglycerides are the chemical form in which most fat exists in food as well as in the

body.

They're also present in blood plasma and form the plasma lipids.

Triglycerides

Normal Less than 150

Borderline-high 150 to 199

High 200 to 499

Very high 500+

How to eat right to lower cholesterol:

Avoid excessive fats

Drink more water

Limit fast foods

Eat regular meals, not just snacks

Where is the FAT?

1. Monounsaturated fat (Good fat)



Are liquid at room temperature

May help lower your total blood cholesterol level

Are thought to raise HDL (good) cholesterol and lower LDL (bad) cholesterol levels

Are found in greatest abundance in canola, olive, and peanut oils

2. Saturated fat (Bad fat)

Are usually solid at room temperature (lard)

Are found in many animal products and tropical oils

Cause the total blood cholesterol level to rise

Section 11-6

Health Habits



Personal development of health habits:

Don’t follow bad examples

Like what you eat, don’t eat what you like

Educate yourself about food

Take time to eat right

What are Daily Living Activities?

Things like:

Dressing yourself

Eating

Bathing

Cleaning your house

What interferes with daily living activities?

Pain

Physical limitations

Body Malfunctions

Stress

Foods highest in saturated fat:

Sausage

Bacon

Fried Chicken

Fried Pork

French Fries

Butter

Fried Chitins

Tacos

Hamburgers

Hotdogs

Diet Downfalls:

At the office

Snacking



No time for a proper meal

Working long hours

Making Dinner

Tasting the food all the time

Cleaning up after dinner

Eating one last nibble

Eating more so you don’t waste it

Watching TV

You keep eating until the show is over

The big bowl

If the bowl is big you will eat everything in it…

Use a smaller bowl

The Body Blues

Sleepy

People eat when tired

But getting tired can be caused by not eating

Eating can make you tired

Hungry

Are you really hungry?

Did something just look good?

Are you stretching your stomach?

Snack happy

If you keep snack near, you will eat them

Eat healthy snacks



Eat meals to avoid excessive snacking

Why are women at risk?

Hormonal issues such as menopause

Increases daily stress

Craving sweets

Eat Something sour

Tell yourself it’s not that good

Don’t buy sweets

Creating a well-balanced Diet

What is your ideal weight?

How did you determine that?

What is your ideal weight?

How did you determine that?

10 Tips for Healthy aging

1. Eat five helpings of fruits and vegetables daily



2. Exercise regularly

3. Get regular health checkups

4. Don’t smoke. If you smoke now QUIT!

5. Practice safe habits to prevent injuries

6. Stay active

7. Avoid overexposure to sun or cold

8. Only drink alcohol in moderation

9. Avoid crash dieting

10. Keep a positive attitude towards life and do things that make you happy

Chapter 11 Review

Critical Thinking



1. As a health care worker, how do your health habits influence others?

2. What would be the best way to begin a diet?

In Review

1. What is the difference between LDL and HDL?

2. Why do people diet?

3. Describe a balanced meal?



Chapter 12

Exercise

Section 12-1

Introduction to Exercise



The hardest part of an exercise routine is getting started. Once you've established a regular

pattern of exercise, you'll find yourself following it.

So, how do you get started?

First consult your doctor

o Your doctor can recommend the specific kinds of exercise for your own

individual needs

Exercise will only become a habit if it's fun!

Pick something you will enjoy doing

If you like being with a group of people, try a team sport like basketball or soccer.

Anyone can exercise

Social activities like dancing

Walking

Bicycling

Swimming

Pilates

Aerobic

Be honest about what you realistically think you can do

Consider your current state of physical fitness

o If you haven't exercised in years, you'll definitely want to start with some modest

activities

o As you get adjusted, you can increase your activity

Consider your schedule

Are you a morning person?

o Then plan to exercise in the morning.

If you're the type that keep hitting your snooze button

o Exercise in the evening

Finally, take it easy

Make sure that you exercise intelligently and cautiously

o Exercise should improve your health, not risk it

Exercise is increasing your heart rate, thus forcing the body to work harder. This activity assists

with several aspects that help you find better health. These include:

http://sln.fi.edu/biosci/healthy/kinds.html



1. Speeds up the body’s metabolism which aids with burning excess fat from the body

2. Increases the heart rate which provide you with better endurance

3. Rids the body of toxins when you sweat

4. Keeps skin softer

5. Keeps muscles tone and tight

6. Keeps you flexible, which help to avoid injuries

Why do you need exercise?

1.

2.

3.

4.

5.

6.

What does exercise do for the body?

1.

2.

3.

How does exercise affect your stress levels?

1.



2.

3.

4.

How to balance your diet and exercise?

1.

2.

3.

4.

5.

6.

7.

8.

9.

Before you exercise:

1.

2.

Dress for exercise:

1.

2.

3.

4.

FYI:

1. Never wipe off sweat! It's your body’s natural cooling system.



2. Did you know that in a normal lifetime a person would walk 65,000 miles!

Benefits of Exercise:

1.

2.

3.

4.

5.

FYI:

The average person gains about 7.5 pounds to their weight during the winter months.

Keys to Exercise:

1.

2.

3.

4.

Common Weight Problems:

1.

2.

3.

Can lack of exercise lead to pain?

1.



2.

Why People Avoid Exercise

Are you too busy to exercise? You’re not alone as studies show about 60% of Americans do not

get the recommended amount of physical activity and about 25% are not active at all. Many

people think exercise is walking to the refrigerator for another bowl of ice with heaping

amounts of chocolate syrup. Bottom line is that the number of people not exercising is far

greater than those who do exercise.

Listed below are the top 10 excuses why people do not exercise, which excuse do you

use?

10. Dislike exercise

9. Have tried exercise but keep quitting

8. Not able to afford a gym membership

7. Not seeing any changes in your body

6. Do not know how to exercise

5. Want to exercise but have to take care of the kids

4. Not motivated enough to exercise

3. Exercise hurts

2. Not able to stick to a routine

1. NO TIME

If you have time to watch TV, you have time to exercise

o It all comes down to personal commitment and the desire to stay healthy

Excuses come cheap

o Staying healthy and in shape is actually a full time job

Section 12-2

How to Exercise



1. Know your Limits

2. Do not try to jump in too fast

3. Consult with your doctor first

4. On a regular basis

5. With Someone

6. Good results take time

7. Attitude is important



8. All bodies are different

9. Newest trends in exercise

10. Deciding what form of exercise is right for you

Precautions for Exercise



1. Never start before consulting a doctor

2. Sometime less is more

3. Always stretch before you exercise

4. Be careful of outdoor running/walking

5. Invest in good exercise clothing

6. Invest in good exercise shoes

7. Stop anytime you feel short of breath

8. Monitor your pulse rate to avoid overexertion

9. Avoid exercise that is too strenuous

10. Find YOUR comfort zone

Complete Fitness

Complete fitness is a combination of diet, nutrition, exercise and living a healthy lifestyle.

Complete fitness will help you be successful in the following areas:

1. Career Success



2. Relationships

3. Financial security

4. Fulfilling and active life

5. Health

6. Personal Happiness

Facts:

1. Only you have the willpower



2. You must want complete fitness

3. Your progress depends on your desire to achieve

4. You do not have to choose diets with bad tasting foods

5. You can overcome bad habits

6. You can release the guilt

7. You can realize you’re potential

8. You can be happy with how you look



Section 12-3

Warming Up

When a muscle is stretched, some of its fibers lengthen, but other fibers may remain at rest. The

more fibers that are stretched, the greater the length developed by the stretched muscles.

Flexibility is defined as "the absolute range of movement in a joint or series of joints that is

attainable in a momentary effort with the help of a partner or a piece of equipment." This

definition tells us that flexibility is not something general but is specific to a particular joint or set

of joints.

Internal influences

o the type of joint (some joints simply aren't meant to be flexible)

o the internal resistance within a joint

o bony structures which limit movement

o the elasticity of muscle tissue (muscle tissue that is scarred due to a previous injury

is not very elastic)

o the elasticity of tendons and ligaments (ligaments do not stretch much and

tendons should not stretch at all)

o the ability of a muscle to relax and contract to achieve the greatest range of

movement

External influences

o the temperature of the place where one is training (a warmer temperature is more

conducive to increased flexibility) THE WARMER THE MUSCLE THE BETTER

THE STRETCH

o the time of day (most people are more flexible in the afternoon than in the

morning, peaking from about 2:30pm-4pm)

o age (pre-adolescents are generally more flexible than adults)

o gender (females are generally more flexible than males)

o one's ability to perform a particular exercise (practice makes perfect)

o one's commitment to achieving flexibility ITS TAKE LOTS OF PRACTICE

o the restrictions of any clothing or equipment

Warming up:

The general warm-up should begin with joint-rotations, starting either from your toes and

working your way up, or from your fingers and working your way down. This facilitates joint

motion by lubricating the entire joint with synovial fluid. You should perform slow circular

movements, both clockwise and counter-clockwise, until the joint seems to move smoothly.



You should rotate the following (in the order given, or in the reverse order):

1. fingers and knuckles

2. wrists

3. elbows

4. shoulders

5. neck

6. trunk/waist

7. hips

8. legs

9. knees

10. ankles

11. toes

What happens when you exercise without stretching?

1.

2.

3.

4.

5.



Section 12-4

Patient Exercise Programs

1. The doctor determines which exercise will best benefit the majority of patients

2. Create written directions

3. Provide visual charts to follow

4. Provide one-on-one training

5. The doctor must follow-up to document progress



6. Have the patient share with you their concerns

Educating Patients

1. Why exercise is part of wellness

2. How they can get started

3. Share your success story

4. Confront their concerns



5. Educated them on what happens to the body without exercise



Section 12 Review

Critical Thinking

1. Write a one page plan to educate patients about the importance of exercise. Include a startup

exercise schedule.

2. How does a person’s attitude influence their workout?

In Review

1. Why is warming up so importance before exercise?

2. List 3 health benefits of exercising?

3. What is the purpose of sweating?

communication skills for physician assistant

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