Demonstrating Impression Making Competency › documents › licensing › special › ...Health and...
Transcript of Demonstrating Impression Making Competency › documents › licensing › special › ...Health and...
![Page 1: Demonstrating Impression Making Competency › documents › licensing › special › ...Health and Wellness for all Arizonans Acceptable Otoscope Excellent bracing and effective](https://reader033.fdocuments.in/reader033/viewer/2022060420/5f171b77bd88a33c5042d56e/html5/thumbnails/1.jpg)
Health and Wellness for all Arizonans
Demonstrating Impression Making Competency
Technical Assistance Illustrating The Acceptability Of Various Actions In
Demonstrating Competency In Making Ear Impressions for the Arizona Hearing Aid
Dispenser Practical Examination.
Jay Griffin, State Licensing Surveyor
1
![Page 2: Demonstrating Impression Making Competency › documents › licensing › special › ...Health and Wellness for all Arizonans Acceptable Otoscope Excellent bracing and effective](https://reader033.fdocuments.in/reader033/viewer/2022060420/5f171b77bd88a33c5042d56e/html5/thumbnails/2.jpg)
Health and Wellness for all Arizonans
About this Technical Assistance Document The following slides are snapshots taken from video captured during actual ear impression-taking demonstrations in the Practical Exam for the Fitting and Dispensing of Hearing Aids in Arizona. Since there are many ways to safely and effectively accomplish ear impressions, this presentation will not attempt to describe or prescribe that you use any particular method. The photos (with explanatory captions) illustrate what kinds of actions will be considered acceptable and not acceptable in demonstrating the making of ear impressions.
2
![Page 3: Demonstrating Impression Making Competency › documents › licensing › special › ...Health and Wellness for all Arizonans Acceptable Otoscope Excellent bracing and effective](https://reader033.fdocuments.in/reader033/viewer/2022060420/5f171b77bd88a33c5042d56e/html5/thumbnails/3.jpg)
Health and Wellness for all Arizonans
How do you properly brace an instrument? Proper bracing means you are effectively controlling the instrument
throughout the procedure so that if the person were to move, the instrument will move the same way. By controlling the instrument so that it stays fixed in the same position relative to the client’s ear, you prevent hurting the patient.
So, failing to properly brace means using the instrument in a way that would allow it to move counter to or against the client, risking harming the person.
The focus is on your effective control of the instrument, not the patient’s head. The methods you use should allow you use the tool effectively in a stable position close to the ear. Sometimes this can be accomplished with the instrument hand alone. But if is necessary to use both hands to control the instrument effectively, you must still maintain proper bracing.
For example, effective use of an otoscope involves inserting the speculum into the ear canal in order to fully inspect the canal and eardrum. So, while using a ‘hovering’ technique (i.e. not actually inserting the speculum into the ear canal) reduces the risk of harm, it also reduces the effectiveness of using the instrument.
You must also maintain this control throughout the entire instrument-to-ear encounter. For example, if your non-instrument hand stops supporting the tip of the impression syringe because you need it to help you finish syringing the material, that will be considered a critical error because you’ve stopped bracing the instrument.
3
![Page 4: Demonstrating Impression Making Competency › documents › licensing › special › ...Health and Wellness for all Arizonans Acceptable Otoscope Excellent bracing and effective](https://reader033.fdocuments.in/reader033/viewer/2022060420/5f171b77bd88a33c5042d56e/html5/thumbnails/4.jpg)
Health and Wellness for all Arizonans
Acceptable Otoscope
While this position looks awkward and it is better if the dispenser were seated, it does demonstrate a bare minimum of bracing with the index fingertip and the long portion of the middle finger.
4
![Page 5: Demonstrating Impression Making Competency › documents › licensing › special › ...Health and Wellness for all Arizonans Acceptable Otoscope Excellent bracing and effective](https://reader033.fdocuments.in/reader033/viewer/2022060420/5f171b77bd88a33c5042d56e/html5/thumbnails/5.jpg)
Health and Wellness for all Arizonans
Acceptable Otoscope
The entire curve of the fingers provides stable contact against the cheek from the tragus to the cheekbone.
5
![Page 6: Demonstrating Impression Making Competency › documents › licensing › special › ...Health and Wellness for all Arizonans Acceptable Otoscope Excellent bracing and effective](https://reader033.fdocuments.in/reader033/viewer/2022060420/5f171b77bd88a33c5042d56e/html5/thumbnails/6.jpg)
Health and Wellness for all Arizonans
Acceptable Otoscope
Another view of the previous slide showing full grasp of the otoscope and the curves of the ring and pinky finger contacting the cheekbone and cheek. Ideally, the bracing contact should be made with the non-moving bony sections on the skull close to the ear.
6
![Page 7: Demonstrating Impression Making Competency › documents › licensing › special › ...Health and Wellness for all Arizonans Acceptable Otoscope Excellent bracing and effective](https://reader033.fdocuments.in/reader033/viewer/2022060420/5f171b77bd88a33c5042d56e/html5/thumbnails/7.jpg)
Health and Wellness for all Arizonans
Acceptable Otoscope
Excellent bracing and effective control is being provided by both hands in this example. The left hand holds the otoscope handle with the middle, ring, and pinky fingers contacting the skull behind the ear. The right hand has three fingers laid out flat on the top of the head above the ear with the head of the otoscope held between the right index finger and thumb.
7
![Page 8: Demonstrating Impression Making Competency › documents › licensing › special › ...Health and Wellness for all Arizonans Acceptable Otoscope Excellent bracing and effective](https://reader033.fdocuments.in/reader033/viewer/2022060420/5f171b77bd88a33c5042d56e/html5/thumbnails/8.jpg)
Health and Wellness for all Arizonans
Acceptable Otoscope
8
![Page 9: Demonstrating Impression Making Competency › documents › licensing › special › ...Health and Wellness for all Arizonans Acceptable Otoscope Excellent bracing and effective](https://reader033.fdocuments.in/reader033/viewer/2022060420/5f171b77bd88a33c5042d56e/html5/thumbnails/9.jpg)
Health and Wellness for all Arizonans
Acceptable Otoscope
This example illustrates bracing using the pinky and hypothenar surface of the hand (the outside edge of the palm).
9
![Page 10: Demonstrating Impression Making Competency › documents › licensing › special › ...Health and Wellness for all Arizonans Acceptable Otoscope Excellent bracing and effective](https://reader033.fdocuments.in/reader033/viewer/2022060420/5f171b77bd88a33c5042d56e/html5/thumbnails/10.jpg)
Health and Wellness for all Arizonans
Acceptable Otoscope
This bracing method is acceptable because the middle and ring fingers are laying flat (providing a lot of contact) and are right underneath the earlobe. If the hand were in the same position but moved farther down on the jaw (which can move independently relative to the ear) it would become unacceptable.
10
![Page 11: Demonstrating Impression Making Competency › documents › licensing › special › ...Health and Wellness for all Arizonans Acceptable Otoscope Excellent bracing and effective](https://reader033.fdocuments.in/reader033/viewer/2022060420/5f171b77bd88a33c5042d56e/html5/thumbnails/11.jpg)
Health and Wellness for all Arizonans
Acceptable Otoscope
The non-instrument hand basically palms the head like a ball with the thumb directly underneath the canal providing a stable stop against which the instrument hand is set. This ‘stacked’ method is acceptable as bracing, but it might not provide adequate effectiveness if the speculum needs to be inserted deeper into the canal.
![Page 12: Demonstrating Impression Making Competency › documents › licensing › special › ...Health and Wellness for all Arizonans Acceptable Otoscope Excellent bracing and effective](https://reader033.fdocuments.in/reader033/viewer/2022060420/5f171b77bd88a33c5042d56e/html5/thumbnails/12.jpg)
Health and Wellness for all Arizonans
Acceptable Otoscope
A good illustration of how dexterity varies from person to person. Almost the entire ring finger is bent an stable against the patient’s cheekbone (not cheek).
12
![Page 13: Demonstrating Impression Making Competency › documents › licensing › special › ...Health and Wellness for all Arizonans Acceptable Otoscope Excellent bracing and effective](https://reader033.fdocuments.in/reader033/viewer/2022060420/5f171b77bd88a33c5042d56e/html5/thumbnails/13.jpg)
Health and Wellness for all Arizonans
UNacceptable Otoscope
The index fingernail of the instrument hand alone against the temple provides stability only if the finger were ‘locked’ and only for head motion vectors in-line with the finger. The client is very likely to be uncomfortable too.
13
![Page 14: Demonstrating Impression Making Competency › documents › licensing › special › ...Health and Wellness for all Arizonans Acceptable Otoscope Excellent bracing and effective](https://reader033.fdocuments.in/reader033/viewer/2022060420/5f171b77bd88a33c5042d56e/html5/thumbnails/14.jpg)
Health and Wellness for all Arizonans
UNacceptable Otoscope
The tip of the pinky touching the cheekbone not only provides no stability for the otoscope, but is far away from the ear canal affecting both stability and effective control.
14
![Page 15: Demonstrating Impression Making Competency › documents › licensing › special › ...Health and Wellness for all Arizonans Acceptable Otoscope Excellent bracing and effective](https://reader033.fdocuments.in/reader033/viewer/2022060420/5f171b77bd88a33c5042d56e/html5/thumbnails/15.jpg)
Health and Wellness for all Arizonans
UNacceptable Otoscope
The otoscope speculum itself is the only thing contacting the ear in this encounter, thus no bracing.
15
![Page 16: Demonstrating Impression Making Competency › documents › licensing › special › ...Health and Wellness for all Arizonans Acceptable Otoscope Excellent bracing and effective](https://reader033.fdocuments.in/reader033/viewer/2022060420/5f171b77bd88a33c5042d56e/html5/thumbnails/16.jpg)
Health and Wellness for all Arizonans
UNacceptable Otoscope
The fingernail ‘back side’ tip of the pinky is the only contact other than the speculum. This provides very little stability against any movement of the head. Using the pinky finger like this makes a very weak position for the instrument hand.
16
![Page 17: Demonstrating Impression Making Competency › documents › licensing › special › ...Health and Wellness for all Arizonans Acceptable Otoscope Excellent bracing and effective](https://reader033.fdocuments.in/reader033/viewer/2022060420/5f171b77bd88a33c5042d56e/html5/thumbnails/17.jpg)
Health and Wellness for all Arizonans
Acceptable Otolight
While the overall position might be a little stiff to be effective, the position of the three fingers of the instrument hand provide at least ‘3 legs’ supporting the otolight.
17
![Page 18: Demonstrating Impression Making Competency › documents › licensing › special › ...Health and Wellness for all Arizonans Acceptable Otoscope Excellent bracing and effective](https://reader033.fdocuments.in/reader033/viewer/2022060420/5f171b77bd88a33c5042d56e/html5/thumbnails/18.jpg)
Health and Wellness for all Arizonans
Acceptable Otolight
Another example of the otolight being controlled as the ‘4th leg’ of the tripod in the instrument hand.
18
![Page 19: Demonstrating Impression Making Competency › documents › licensing › special › ...Health and Wellness for all Arizonans Acceptable Otoscope Excellent bracing and effective](https://reader033.fdocuments.in/reader033/viewer/2022060420/5f171b77bd88a33c5042d56e/html5/thumbnails/19.jpg)
Health and Wellness for all Arizonans
Acceptable Otolight
The palm and curled knuckles of the instrument hand provides a very stable contact against primarily bony portions of the client’s head.
19
![Page 20: Demonstrating Impression Making Competency › documents › licensing › special › ...Health and Wellness for all Arizonans Acceptable Otoscope Excellent bracing and effective](https://reader033.fdocuments.in/reader033/viewer/2022060420/5f171b77bd88a33c5042d56e/html5/thumbnails/20.jpg)
Health and Wellness for all Arizonans
Acceptable Otolight
An example of hypothenar stability using the otolight.
20
![Page 21: Demonstrating Impression Making Competency › documents › licensing › special › ...Health and Wellness for all Arizonans Acceptable Otoscope Excellent bracing and effective](https://reader033.fdocuments.in/reader033/viewer/2022060420/5f171b77bd88a33c5042d56e/html5/thumbnails/21.jpg)
Health and Wellness for all Arizonans
Acceptable Otolight
21
![Page 22: Demonstrating Impression Making Competency › documents › licensing › special › ...Health and Wellness for all Arizonans Acceptable Otoscope Excellent bracing and effective](https://reader033.fdocuments.in/reader033/viewer/2022060420/5f171b77bd88a33c5042d56e/html5/thumbnails/22.jpg)
Health and Wellness for all Arizonans
Acceptable Otolight
While acceptable, this technique could be improved if the instrument pinky and ring fingers were wrapped around the thumb or tucked into the ‘pocket’ of the palm.
22
![Page 23: Demonstrating Impression Making Competency › documents › licensing › special › ...Health and Wellness for all Arizonans Acceptable Otoscope Excellent bracing and effective](https://reader033.fdocuments.in/reader033/viewer/2022060420/5f171b77bd88a33c5042d56e/html5/thumbnails/23.jpg)
Health and Wellness for all Arizonans
Acceptable Otolight
23
![Page 24: Demonstrating Impression Making Competency › documents › licensing › special › ...Health and Wellness for all Arizonans Acceptable Otoscope Excellent bracing and effective](https://reader033.fdocuments.in/reader033/viewer/2022060420/5f171b77bd88a33c5042d56e/html5/thumbnails/24.jpg)
Health and Wellness for all Arizonans
UNacceptable Otolight
The instrument is the only thing making contact with the ear. Notice that the middle of the arm is resting on the shoulder which provides no stability against head motions.
24
![Page 25: Demonstrating Impression Making Competency › documents › licensing › special › ...Health and Wellness for all Arizonans Acceptable Otoscope Excellent bracing and effective](https://reader033.fdocuments.in/reader033/viewer/2022060420/5f171b77bd88a33c5042d56e/html5/thumbnails/25.jpg)
Health and Wellness for all Arizonans
UNacceptable Otolight
The instrument hand has no contact with the head and the left hand pinky finger is insufficient for providing bracing in this position.
25
![Page 26: Demonstrating Impression Making Competency › documents › licensing › special › ...Health and Wellness for all Arizonans Acceptable Otoscope Excellent bracing and effective](https://reader033.fdocuments.in/reader033/viewer/2022060420/5f171b77bd88a33c5042d56e/html5/thumbnails/26.jpg)
Health and Wellness for all Arizonans
UNacceptable Otolight
A single finger providing contact of the instrument hand with the head is always unacceptable. This ‘pogo stick’ method is better than no bracing, but it is inadequate because it can only brace and control in the same vector as the finger.
26
![Page 27: Demonstrating Impression Making Competency › documents › licensing › special › ...Health and Wellness for all Arizonans Acceptable Otoscope Excellent bracing and effective](https://reader033.fdocuments.in/reader033/viewer/2022060420/5f171b77bd88a33c5042d56e/html5/thumbnails/27.jpg)
Health and Wellness for all Arizonans
UNacceptable Otolight
27
![Page 28: Demonstrating Impression Making Competency › documents › licensing › special › ...Health and Wellness for all Arizonans Acceptable Otoscope Excellent bracing and effective](https://reader033.fdocuments.in/reader033/viewer/2022060420/5f171b77bd88a33c5042d56e/html5/thumbnails/28.jpg)
Health and Wellness for all Arizonans
UNacceptable Otolight
28
![Page 29: Demonstrating Impression Making Competency › documents › licensing › special › ...Health and Wellness for all Arizonans Acceptable Otoscope Excellent bracing and effective](https://reader033.fdocuments.in/reader033/viewer/2022060420/5f171b77bd88a33c5042d56e/html5/thumbnails/29.jpg)
Health and Wellness for all Arizonans
UNacceptable Otolight
Pinky fingertip of instrument hand (itself insufficient) against the soft part of the cheek which provides no stability.
29
![Page 30: Demonstrating Impression Making Competency › documents › licensing › special › ...Health and Wellness for all Arizonans Acceptable Otoscope Excellent bracing and effective](https://reader033.fdocuments.in/reader033/viewer/2022060420/5f171b77bd88a33c5042d56e/html5/thumbnails/30.jpg)
Health and Wellness for all Arizonans
UNacceptable Otolight
30
![Page 31: Demonstrating Impression Making Competency › documents › licensing › special › ...Health and Wellness for all Arizonans Acceptable Otoscope Excellent bracing and effective](https://reader033.fdocuments.in/reader033/viewer/2022060420/5f171b77bd88a33c5042d56e/html5/thumbnails/31.jpg)
Health and Wellness for all Arizonans
UNacceptable Otolight
This frame shows what could have been acceptable bracing not being maintained throughout the procedure. The ring and pinky fingers of the instrument hand have lifted away from the head.
31
![Page 32: Demonstrating Impression Making Competency › documents › licensing › special › ...Health and Wellness for all Arizonans Acceptable Otoscope Excellent bracing and effective](https://reader033.fdocuments.in/reader033/viewer/2022060420/5f171b77bd88a33c5042d56e/html5/thumbnails/32.jpg)
Health and Wellness for all Arizonans
UNacceptable Otolight
Not only is this highly inadequate for bracing, it’s uncomfortable to the patient.
32
![Page 33: Demonstrating Impression Making Competency › documents › licensing › special › ...Health and Wellness for all Arizonans Acceptable Otoscope Excellent bracing and effective](https://reader033.fdocuments.in/reader033/viewer/2022060420/5f171b77bd88a33c5042d56e/html5/thumbnails/33.jpg)
Health and Wellness for all Arizonans
Acceptable Syringe
The non-instrument hand is mostly ‘palmed’ on the back of the head and the index finger and thumb are holding and controlling the syringe cartridge tip very close to the ear. This method is also useful with the otoscope and otolight.
33
![Page 34: Demonstrating Impression Making Competency › documents › licensing › special › ...Health and Wellness for all Arizonans Acceptable Otoscope Excellent bracing and effective](https://reader033.fdocuments.in/reader033/viewer/2022060420/5f171b77bd88a33c5042d56e/html5/thumbnails/34.jpg)
Health and Wellness for all Arizonans
Acceptable Syringe
Same technique as the previous slide but using a manual syringe. This provides excellent stability and control of the syringe tip letting the other hand exercise full compression of the plunger.
34
![Page 35: Demonstrating Impression Making Competency › documents › licensing › special › ...Health and Wellness for all Arizonans Acceptable Otoscope Excellent bracing and effective](https://reader033.fdocuments.in/reader033/viewer/2022060420/5f171b77bd88a33c5042d56e/html5/thumbnails/35.jpg)
Health and Wellness for all Arizonans
Acceptable Syringe
While a bit limited in control flexibility, the syringe tip is locked within the ‘scissors’ of the index and middle finger.
35
![Page 36: Demonstrating Impression Making Competency › documents › licensing › special › ...Health and Wellness for all Arizonans Acceptable Otoscope Excellent bracing and effective](https://reader033.fdocuments.in/reader033/viewer/2022060420/5f171b77bd88a33c5042d56e/html5/thumbnails/36.jpg)
Health and Wellness for all Arizonans
Acceptable Syringe
An example of the first method but braced on the face side of the client rather than the back of the head.
36
![Page 37: Demonstrating Impression Making Competency › documents › licensing › special › ...Health and Wellness for all Arizonans Acceptable Otoscope Excellent bracing and effective](https://reader033.fdocuments.in/reader033/viewer/2022060420/5f171b77bd88a33c5042d56e/html5/thumbnails/37.jpg)
Health and Wellness for all Arizonans
Acceptable Syringe
Again, while limited in control flexibility, which you can see by the impression material bulging out above the tip, the syringe tip is very stable close to the ear.
37
![Page 38: Demonstrating Impression Making Competency › documents › licensing › special › ...Health and Wellness for all Arizonans Acceptable Otoscope Excellent bracing and effective](https://reader033.fdocuments.in/reader033/viewer/2022060420/5f171b77bd88a33c5042d56e/html5/thumbnails/38.jpg)
Health and Wellness for all Arizonans
Acceptable Syringe
38
![Page 39: Demonstrating Impression Making Competency › documents › licensing › special › ...Health and Wellness for all Arizonans Acceptable Otoscope Excellent bracing and effective](https://reader033.fdocuments.in/reader033/viewer/2022060420/5f171b77bd88a33c5042d56e/html5/thumbnails/39.jpg)
Health and Wellness for all Arizonans
Acceptable Syringe
39
![Page 40: Demonstrating Impression Making Competency › documents › licensing › special › ...Health and Wellness for all Arizonans Acceptable Otoscope Excellent bracing and effective](https://reader033.fdocuments.in/reader033/viewer/2022060420/5f171b77bd88a33c5042d56e/html5/thumbnails/40.jpg)
Health and Wellness for all Arizonans
Acceptable Syringe
40
![Page 41: Demonstrating Impression Making Competency › documents › licensing › special › ...Health and Wellness for all Arizonans Acceptable Otoscope Excellent bracing and effective](https://reader033.fdocuments.in/reader033/viewer/2022060420/5f171b77bd88a33c5042d56e/html5/thumbnails/41.jpg)
Health and Wellness for all Arizonans
Acceptable Syringe
41
![Page 42: Demonstrating Impression Making Competency › documents › licensing › special › ...Health and Wellness for all Arizonans Acceptable Otoscope Excellent bracing and effective](https://reader033.fdocuments.in/reader033/viewer/2022060420/5f171b77bd88a33c5042d56e/html5/thumbnails/42.jpg)
Health and Wellness for all Arizonans
Acceptable Syringe
42
![Page 43: Demonstrating Impression Making Competency › documents › licensing › special › ...Health and Wellness for all Arizonans Acceptable Otoscope Excellent bracing and effective](https://reader033.fdocuments.in/reader033/viewer/2022060420/5f171b77bd88a33c5042d56e/html5/thumbnails/43.jpg)
Health and Wellness for all Arizonans
UNacceptable Syringe
There is effectively not difference between this position and if you took the non-instrument hand away. The left hand is neither stabilizing nor controlling the cartridge tip in any way.
43
![Page 44: Demonstrating Impression Making Competency › documents › licensing › special › ...Health and Wellness for all Arizonans Acceptable Otoscope Excellent bracing and effective](https://reader033.fdocuments.in/reader033/viewer/2022060420/5f171b77bd88a33c5042d56e/html5/thumbnails/44.jpg)
Health and Wellness for all Arizonans
UNacceptable Syringe
44
![Page 45: Demonstrating Impression Making Competency › documents › licensing › special › ...Health and Wellness for all Arizonans Acceptable Otoscope Excellent bracing and effective](https://reader033.fdocuments.in/reader033/viewer/2022060420/5f171b77bd88a33c5042d56e/html5/thumbnails/45.jpg)
Health and Wellness for all Arizonans
UNacceptable Syringe
45
![Page 46: Demonstrating Impression Making Competency › documents › licensing › special › ...Health and Wellness for all Arizonans Acceptable Otoscope Excellent bracing and effective](https://reader033.fdocuments.in/reader033/viewer/2022060420/5f171b77bd88a33c5042d56e/html5/thumbnails/46.jpg)
Health and Wellness for all Arizonans
UNacceptable Syringe
The force the non-instrument hand thumb applies to the base of the cartridge tip provides no bracing against head movement vectors.
46
![Page 47: Demonstrating Impression Making Competency › documents › licensing › special › ...Health and Wellness for all Arizonans Acceptable Otoscope Excellent bracing and effective](https://reader033.fdocuments.in/reader033/viewer/2022060420/5f171b77bd88a33c5042d56e/html5/thumbnails/47.jpg)
Health and Wellness for all Arizonans
UNacceptable Syringe
As with the otolight, single pinky ‘pogo stick’ provides very little stability in the event the patient moves their head. It may also become difficult to compress the syringe.
47
![Page 48: Demonstrating Impression Making Competency › documents › licensing › special › ...Health and Wellness for all Arizonans Acceptable Otoscope Excellent bracing and effective](https://reader033.fdocuments.in/reader033/viewer/2022060420/5f171b77bd88a33c5042d56e/html5/thumbnails/48.jpg)
Health and Wellness for all Arizonans
UNacceptable Syringe
Continuing from the previous slide, the person did encounter difficulty with injecting the impression material and ended up providing no bracing of the instrument in the process. It is important to understand the viscosity and curing characteristics of the impression material you use. You should also choose a syringe and material that is appropriate for your dexterity and skill.
48
![Page 49: Demonstrating Impression Making Competency › documents › licensing › special › ...Health and Wellness for all Arizonans Acceptable Otoscope Excellent bracing and effective](https://reader033.fdocuments.in/reader033/viewer/2022060420/5f171b77bd88a33c5042d56e/html5/thumbnails/49.jpg)
Health and Wellness for all Arizonans
UNacceptable Syringe
49
![Page 50: Demonstrating Impression Making Competency › documents › licensing › special › ...Health and Wellness for all Arizonans Acceptable Otoscope Excellent bracing and effective](https://reader033.fdocuments.in/reader033/viewer/2022060420/5f171b77bd88a33c5042d56e/html5/thumbnails/50.jpg)
Health and Wellness for all Arizonans
UNacceptable Syringe
50
![Page 51: Demonstrating Impression Making Competency › documents › licensing › special › ...Health and Wellness for all Arizonans Acceptable Otoscope Excellent bracing and effective](https://reader033.fdocuments.in/reader033/viewer/2022060420/5f171b77bd88a33c5042d56e/html5/thumbnails/51.jpg)
Health and Wellness for all Arizonans
UNacceptable Syringe
You can take the left hand away without any change in the effect of instrument bracing or control.
51
![Page 52: Demonstrating Impression Making Competency › documents › licensing › special › ...Health and Wellness for all Arizonans Acceptable Otoscope Excellent bracing and effective](https://reader033.fdocuments.in/reader033/viewer/2022060420/5f171b77bd88a33c5042d56e/html5/thumbnails/52.jpg)
Health and Wellness for all Arizonans
UNacceptable Syringe
52
![Page 53: Demonstrating Impression Making Competency › documents › licensing › special › ...Health and Wellness for all Arizonans Acceptable Otoscope Excellent bracing and effective](https://reader033.fdocuments.in/reader033/viewer/2022060420/5f171b77bd88a33c5042d56e/html5/thumbnails/53.jpg)
Health and Wellness for all Arizonans
UNacceptable Syringe
A frame showing a failure to maintain bracing throughout the ear encounter.
53
![Page 54: Demonstrating Impression Making Competency › documents › licensing › special › ...Health and Wellness for all Arizonans Acceptable Otoscope Excellent bracing and effective](https://reader033.fdocuments.in/reader033/viewer/2022060420/5f171b77bd88a33c5042d56e/html5/thumbnails/54.jpg)
Health and Wellness for all Arizonans
UNacceptable Syringe
54
![Page 55: Demonstrating Impression Making Competency › documents › licensing › special › ...Health and Wellness for all Arizonans Acceptable Otoscope Excellent bracing and effective](https://reader033.fdocuments.in/reader033/viewer/2022060420/5f171b77bd88a33c5042d56e/html5/thumbnails/55.jpg)
Health and Wellness for all Arizonans
UNacceptable Syringe
55
![Page 56: Demonstrating Impression Making Competency › documents › licensing › special › ...Health and Wellness for all Arizonans Acceptable Otoscope Excellent bracing and effective](https://reader033.fdocuments.in/reader033/viewer/2022060420/5f171b77bd88a33c5042d56e/html5/thumbnails/56.jpg)
Health and Wellness for all Arizonans
UNacceptable Syringe
The infamous embedded fingernail has returned.
56