Ballweg's Physician Assistant: A Guide to Clinical Practice

606 Pages·2021·24.297 MB·English

by  Tamara Ritsema PhD MPH PA-C/R, Darwin Brown MPH PA-C DFAAPA, Daniel Vetrosky PhD PA-C DFAAPA

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Ballweg’s Physician Assistant
A Guide to Clinical Practice
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Ballweg’s Physician
Assistant
A Guide to Clinical Practice
SEVENTH EDITION
Senior Editors
Tamara S. Ritsema, PhD, MPH, MMSc, PA-C/R
Associate Professor, Department of Physician Assistant Studies, George Washington University
School of Medicine and Health Sciences, Washington, DC
Adjunct Senior Lecturer, Physician Assistant Programme, St. George‘s, University of London,
London, United Kingdom
Darwin L. Brown, MPH, PA-C, DFAAPA
Assistant Professor, Physician Assistant Program, Creighton University School of Medicine, Omaha,
Nebraska
Daniel T. Vetrosky, PhD, PA-C, DFAAPA
Associate Professor (Ret.), Department of Physician Assistant Studies, University of South Alabama,
Mobile, Alabama
Associate Editors
Bettie Coplan, PhD, PA-C
Assistant Professor, Department of Physician Assistant Studies, Northern Arizona University,
Phoenix, Arizona,
Adjunct Faculty, College of Health Solutions, Arizona State University, Phoenix, Arizona
Michael J. MacLean, MS, PA-C
Director and Assistant Professor – Physician Assistant Program, Medical Education,
Northwestern University Feinberg School of Medicine, Chicago, Illinois
Joseph Zaweski, MPAS, PA-C
Associate Professor, Assistant Dean and Director – Physician Assistant Program, College of Nursing
and Health Professions, Valparaiso University, Valparaiso, Indiana
Editor Emeritus
Ruth Ballweg, MPH, PA-C Emeritus, DFAAPA
Professor Emeritus, Department of Family Medicine, University of Washington School of Medicine,
Seattle, Washington
Director of International Affairs, National Commission on Certification of Physician Assistants,
Johns Creek, Georgia
Elsevier
3251 Riverport Lane
St. Louis, Missouri 63043
BALLWEG’S PHYSICIAN ASSISTANT: A GUIDE TO CLINICAL PRACTICE,
SEVENTH EDITION ISBN: 978-0-323-65416-6
Copyright © 2022 by Elsevier, Inc. All rights reserved.
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This book and the individual contributions contained in it are protected under copyright by the Publisher
(other than as may be noted herein).
Notice
Practitioners and researchers must always rely on their own experience and knowledge in evaluating and
using any information, methods, compounds or experiments described herein. Because of rapid
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Previous editions copyrighted 2018, 2013, 2008, 2003, 1999, and 1994
International Standard Book Number: 978-0-323-65416-6
Content Strategist: Lauren Willis
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Publishing Services Manager: Shereen Jameel
Project Manager: Aparna Venkatachalam
Design Direction: Patrick Ferguson
Printed in Canada
Last digit is the print number: 9 8 7 6 5 4 3 2 1
Contributors
David P. Asprey, PhD, PA-C Rhonda Campbell, MS, PA-C
Associate Dean of Medical Education and Professional Physician Assistant, Certified, Advanced Heart Failure,
Programs; Chair, Department of Physician Assistant LVAD and Transplant, Emory Saint Joseph’s Hospital,
Studies, University of Iowa, Department of Physician Atlanta, Georgia
Assistant Studies and Services, Iowa City, Iowa
Jeff W. Chambers, PA-C
Ruth Ballweg, MPH, PA-C Emeritus, DFAAPA Deputy Commander, United States Air Force Air National
Professor Emeritus, Department of Family Medicine, Guard, 187th FW MDG CERFP Det.1, Montgomery,
University of Washington School of Medicine, Seattle, Alabama
Washington
Director of International Affairs, National Commission Torry Cobb, DHSc, MPH, MHS, PA-C
on Certification of Physician Assistants, Johns Creek, Assistant Professor, St. Francis University, Departments
Georgia of Health Science and Medical Science, Loretto,
Pennsylvania
Kate S. Bascombe, BSc Hons, PG Dip PGCert HBE, FHEA
Deputy Course Director, St George’s University of London, Roy Constantine, PhD, MPH, PA-C – FCCM, DFAAPA
Master’s in Physician Associate Studies (MPAS), Assistant Director of Advanced Practice Provider
London, United Kingdom Services. St. Francis Hospital – The Heart Center,
Roslyn, New York
Katie Beaudoin, DMS, PA-C Professor of Health Sciences College of Health and
Adjunct Faculty, Butler University, College of Pharmacy Human Services Trident at American Intercontinental
and Health Sciences, Physician Assistant Studies, University
Indianapolis, Indiana Lecturer Master of Science in Health Sciences for
Physician Assistants Program - Weill Cornell Graduate
Wallace Boeve, EdD, PA-C School of Medical Sciences Weill Cornell Medicine,
Dean, Des Moines Univeristy, College of Health Sciences, New York, New York
Des Moines, Iowa
Marci Contreras, MPAS, PA-C
Jonathan M. Bowser, PA-C Program Director and Associate Professor, Franklin Pierce
Program Director, Associate Professor, University of Colorado, University, Department of Physician Assistant Studies,
Physician Assistant Program, Aurora, Colorado Goodyear, Arizona
Erika Bramlette, MBA, PA-C Bettie Coplan, PhD, PA-C
Assistant Professor, George Washington University, Assistant Professor, Department of Physician Assistant
Department of Physician Assistant Studies, Studies, Northern Arizona University, Phoenix, Arizona
Washington, DC Adjunct Faculty, College of Health Solutions, Arizona
State University, Phoenix, Arizona
Anthony Brenneman, MPAS, PA-C
Program Director and Clinical Professor, University of Dan Crouse, MPAS, PA-C
Iowa, Department of Physician Assistant Studies and Associate Professor, University of Utah, Department of
Services, Iowa City, Iowa Family and Preventive Medicine, Salt Lake City, Utah
Darwin L. Brown, MPH, PA-C, DFAAPA Sondra M. DePalma, DHSc, PA-C, CLS, CHS, FNLA,
Assistant Professor, Physician Assistant Program, Creighton AACC, DFAAPA
University School of Medicine, Omaha, Nebraska Director, American Academy of PAs, Reimbursement
and Professional Advocacy, Alexandria, Virginia
Mary L. Brubaker, PharmD, PA-C, BCPS, FASHP Adjunct Assistant Professor, A.T. Still University, Arizona
Associate Clinical Professor, Northern Arizona University, School of Health Sciences, Doctor of Medical Science
Department of Physician Assistant Studies, Phoenix, Program, Mesa, Arizona
Arizona
Michelle Buller Petersen, MMS, PA-C
Professor, Academic Director, Union College, PA Program,
Lincoln, Nebraska
v
vi Contributors
Rachel Ditoro, MSPAS, PA-C Robin N. Hunter Buskey, DHSc, PA-C
Associate Professor, Director of Educational Competency Chief, Clinical Services Support Unit, Department
and Strategic Innovation, Salus University, Department of Homeland Security, Immigration & Custom
of Physician Assistant Studies, Elkins Park, Pennsylvania Enforcement (ICE) Enforcement and Removal
Operations, ICE Health Service Corps,
Ron Dohanish, MMS, PA-C Washington, DC
Physician Assistant, Christianacare, Physical Medicine
and Rehabilitation, Wilmington, Delaware Melissa Jensen, MSPA, PA-C
Assistant Professor, Associate Program Director,
Jerry Erickson, DMSc, PA-C University of Charleston, Department of Physician
Associate Professor and Program Director, Brenau Assistant Studies, Charleston, West Virginia
University, Department of Physician Assistant Studies,
Gainesville, Georgia James C. Johnson, III, DMSc, PA-C
Assistant Professor, High Point University, Department
Christine M. Everett, PhD, MPH, PA-C of Physician Assistant Studies, High Point, North
Associate Professor, Duke University, Carolina
Departments of Family and Community Medicine &
Population Health Sciences, Durham, North Carolina Sharona Kanofsky, MsCH, PA-C, CCPA
Associate Professor, Teaching Stream, University of Toronto,
Jennifer Feirstein, MSPAS, PA-C, DFAAPA Department of Family & Community Medicine, Toronto,
Assistant Clinical Professor, Northern Arizona University, Ontario, Canada
Department of Physician Assistant Studies, Phoenix,
Arizona Gerald Kayingo, PhD, PA-C
Assistant Dean, Executive Director and Professor,
Christopher P. Forest, DHSc, PA-C, DFAAPA Physician Assistant Leadership and Learning Academy,
Professor, Founding Program Director, California State University of Maryland Baltimore, Graduate School,
University, Monterey Bay, Master of Science Physician Baltimore Maryland
Assistant Program, Salinas, California
Bri Kestler, MMS, PA-C
Earl G. Greene III, JD Physician Assistant, University of South Alabama,
Senior Counsel, Gordon & Reese, LLP, Omaha, Nebraska Simulation Program, Mobile, Alabama
Noelle Hammerbacher, MS William C. Kohlhepp, DHSc, PA-C
Freelance Writer and Medical Editor Professor Emeritus, Quinnipiac University, Department of
Physician Assistant Studies, Hamden, Connecticut
Debra A. Herrmann, DHSc, MHS, PA-C
Assistant Professor, George Washington University, David H. Kuhns, MPH, PA-C Emeritus, CCPA -Retired,
Department of Physician Assistant Studies, DFAAPA
Washington DC Consultant on International Development of the PA
Profession, Cumberland Center, Maine
Erin J. Hoffman, MPAS, PA-C
Assistant Professor, Creighton University, Department Luppo Kuilman, PhD, MPA
of Medical Education, Omaha, Nebraska Program Manager, Hanze University of Applied Sciences,
Groningen, School of Health Care Studies, Master
Trenton Honda, PhD, MMS, PA-C Physician Assistant Program, Netherlands
Clinical Professor, Northeastern University, Adjunct Faculty, Northern Arizona University,
Department of Physician Assistant Studies, Boston, College of Health and Human Services, Department
Massachusetts of Physician Assistant Studies, Phoenix, Arizona
Theresa V. Horvath, MPH, PA-C Susan LeLacheur, DrPH, PA-C
PA Program Director Emeritus, Marist College, Professor, The George Washington University School of
Department of Physician Assistant Studies, Medicine and Health Sciences, Department of Physician
Poughkeepsie, New York Assistant Studies, Washington DC
Nicholas M. Hudak, MPA, MSEd, PA-C Jason Lesandrini, MA, FACHE, LPEC, HEC-C
Associate Professor, Physician Assistant, Duke University Assistant Vice President of Ethics, Advance Care Planning
School of Medicine, Department of Family Medicine and and Spiritual Health, Wellstar Health System, Ethics
Community Health, Division of Physician Assistant Department, Atlanta, Georgia
Studies, Durham, North Carolina
Contributors vii
Marissa Liveris, MMS, PA-C Lillian Navarro-Reynolds, MS, PA-C
Instructor, Northwestern University Feinberg School Director of Academic Education, Assistant Professor,
of Medicine, Department of Medical Education, Oregon Health & Science University, Division of
Chicago, Illinois Physician Assistant Education, Portland, Oregon
Sharon L. Luke, EdD, PA-C Sharon Pelekanos, MHS, PA-C
Executive Director, Accreditation Review Commission on Assistant Professor, University of South Alabama,
Education for the Physician Assistant, Johns Creek, Department of Physician Assistant Studies, Mobile,
Georgia Alabama
Erin Lunn, MHS, PA-C Ron W. Perry, MS, MPAS, MEd, PA-C Emeritus
Assistant Professor, Director of Clinical Education, Physician Assistant - Navy Commander (retired),
University of South Alabama, Department of Comal ISD, Health Science, Fischer, Texas
Physician Assistant Studies, Mobile, Alabama
Maura N. Polansky, MS, MHPE, PA-C, DFAAPA
Michael J. MacLean, MS, PA-C Associate Professor, George Washington University,
Director and Assistant Professor – Physician Assistant Physician Assistant Studies, Washington, DC
Program, Medical Education,
Northwestern University Feinberg School of Medicine, Antoinette Polito, MHS, PA-C
Chicago, Illinois Associate Professor, Elon University, Department of
Physician Assistant Studies, Elon, North Carolina
Rebecca Maldonado, MSHPE, PA-C
Associate Professor, University of Colorado, Department of Michael L. Powe, BS
Pediatrics, Aurora, Colorado Vice President, American Academy of PAs, Reimbursement
& Advocacy, Alexandria, Virginia
Virginia McCoy Hass, DNP, FNP-C, PA-C George Washington University, Adjunct Assistant
Associate Clinical Professor (retired), Betty Irene Moore Professor, Department of Physician Assistant Studies,
School of Nursing’s at UC Davis, Sacramento, California Washington, DC
Anthony A. Miller, MEd, PA-C, DFAAPA Brenda Quincy, PhD, MPH, PA-C
Distinguished Professor, Shenandoah University, Division Professor, Butler University, Department of Health
of Physician Assistant Studies, Winchester, Virginia Sciences, Indianapolis, Indiana
Erika Miller, BA Stephanie M. Radix, JD
Director, State Advocacy & Outreach, Senior Director, American Academy of PAs (AAPA),
American Academy of PAs, Alexandria, Virginia State Advocacy & Outreach, Alexandria, Virginia
Elana A. Min, PhD, PA-C Scott D. Richards, PhD, PA-C, DFAAPA
Clinical Education Director, Northwestern Feinberg MSPA Program Director and Associate Professor,
School of Medicine, Department of Medical Education/ Monmouth University, Master of Science PA Program,
Physician Assistant Program, Chicago, Illinois School of Nursing and Health Studies, West Long
Branch, New Jersey
Margaret Moore-Nadler, DNP, RN
Associate Professor, University of South Alabama, Robin D. Risling, PA-C, MHS
Community Mental Health, Mobile, Alabama Program Director & Assistant Clinical Professor,
Physician Assistant Studies, University of New England,
Nicole Mortier, MHS, PA-C Portland, Maine
Assistant Professor, George Washington University,
Department of Physician Assistant Studies, Tamara S. Ritsema, PhD, MPH, MMSc, PA-C/R
Washington DC Associate Professor, Department of Physician Assistant
Studies, George Washington University
Dawn Morton-Rias, EdD, PA-C School of Medicine and Health Sciences,
President/CEO, National Commission on Certification of Washington, DC
Physician Assistants (NCCPA), Johns Creek, Georgia Adjunct Senior Lecturer, Physician Assistant Programme,
Professor and Former Dean, SUNY Downstate Health St. George‘s, University of London,
Sciences University, Professor and Former Dean, London, United Kingdom
College of Health Professions, Brooklyn, New York
Karen Roberts, MSc, PA-C/R, FHEA
Karen E. Mulitalo, MPAS, PA-C Reader in Physician Associate Education, Brighton and
Assistant Professor, Utah Valley University, Sussex Medical School, Department of Medical Education,
Department of Physician Assistant Studies, Orem, Utah Brighton, United Kingdom
University of Utah, Associate Professor, Department of
Family and Preventive Medicine, Salt Lake City, Utah
viii Contributors
Elizabeth P. Rothschild, MMSc, PA-C Stephane P. VanderMeulen, MA, MPAS, PA-C
Assistant Professor, Emory University, Physician Assistant Associate Professor, Founding Program Director,
Program, Atlanta, Georgia Creighton University, School of Medicine, Omaha,
Nebraska
Pamela L. Ruane, PhD, MHS, PA-C
Associate Professor, Lock Haven University, Department Jill Vargo Cavalet, DHSc, MHS, PA-C
of Physician Assistant Studies, Lock Haven, Clinical Professor, Saint Francis University, Department of
Pennsylvania Physician Assistant Science, Loretto, Pennsylvania
Cody A. Sasek, PhD, PA-C Daniel T. Vetrosky, PhD, PA-C, DFAAPA
Assistant Professor, Creighton University, Associate Professor (Ret.), Department of Physician
School of Medicine, Physician Assistant Program, Assistant Studies, University of South Alabama,
Omaha, Nebraska Mobile, Alabama
Patty J. Scholting, MPAS, MPH, PA-C Carson S. Walker, JD
Assistant Professor, Director of Curriculum and Director, American Academy of Physician Assistants,
Assessment, Creighton University, School of State Advocacy and Outreach, Alexandria, Virginia
Medicine, Physician Assistant Program, Omaha,
Nebraska Lisa K. Walker, MPAS, PA-C
Associate Professor, MGH Institute of Health Professions,
Craig Scott, PhD Physician Assistant Program, Boston, Massachusetts
Emeritus Professor, Department of Biomedical Informatics
and Medical Education, University of Washington, Jennifer B. Wall, MSPAS, PA-C
Seattle, Washington Physician Assistant, Critical Care, Inova Hospital,
Falls Church,Virginia
Jacqueline Sivahop, EdD, PA-C
Associate Professor, University of Colorado, Meredith L. Wall, MPAS, PA-C
Child Health Associate/Physician Assistant Program, Associate Clinical Professor & Academic Coordinator,
Department of Pediatrics, Aurora, Colorado University of New England, Department of Physician
Assistant Studies, Portland, Maine
Jennifer A. Snyder, PhD, PA-C, DFAAPA
Associate Dean and Professor, Butler University, College of Chantelle Wolpert, PhD, MBA, GC, PA-C
Pharmacy and Health Sciences, Indianapolis, Indiana Consultant, Durham, North Carolina
Justine Strand de Oliveira, DrPH, PA-C, DFAAPA Johnna K. Yealy, PhD, PA-C
Professor Emeritus, Duke University, Department of Dept. Chair/Program Director, The University of Tampa,
Family Medicine and Community Health, Durham, Department of Physician Assistant Medicine,
North Carolina Tampa, Florida
Universidade do Algarve, Professora Catedátrica
Convidada, Mestrado Integrado em Medicina, Faro, Joseph Zaweski, MPAS, PA-C
Algarve, Portugal Associate Professor, Assistant Dean and Director –
Physician Assistant Program, College of Nursing
Maggie Thayer, MPAS, PA-C and Health Professions, Valparaiso University,
Outreach Associate Medical Director, Circle the City, Valparaiso, Indiana
Phoenix, Arizona
Olivia Ziegler, MS, PA
Virginia L. Valentin, DrPH, PA-C Chief Assessment Officer, Physician Assistant Education
Division Chief, Associate Professor, University of Utah, Association, Washington, DC
Division of Physician Assistant Studies,
Salt Lake City, Utah