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Diagnostic Medical Sonography, BS

The field of diagnostic medical sonography has rapidly advanced over the years. With new and advanced tools available today, the role of the imaging professional and the needs of the patient have grown dramatically.

Nebraska Methodist College has designed a program for the medical imaging professional who wishes to specialize in the care of women. Graduates will be skilled in serving patients with unique psycho/social needs, including coping with fetal loss, breast cancer, infertility, and the complexities of high risk obstetrics.

The Bureau of Labor Statistics indicates the U.S. median salary in May 2022 for diagnostic medical sonographers was $78,210 per year, with a faster than average projected job growth of 10 percent between 2022 and 2032.

Program Perks
  • Hands-on learning in high-tech labs helps improve skills & confidence
  • Clinical rotations expose you to diverse populations, facilities and technology
  • Experienced, certified faculty who integrate real-world experiences into the coursework
  • Supportive community
  • Bachelor's degree completion portion tailored to working professionals
  • Framework & course design provides flexibility to balance professional and personal commitments
  • Interested in minoring in Spanish? Find out more
CAAHEP

Accreditation & Licensure

The Diagnostic Medical Sonography program is accredited by the Commission on Accreditation of Allied Health Education Programs  upon the recommendation of the Joint Review Committee on Education in Diagnostic Medical Sonography. Commission on Accreditation of Allied Health Education Programs, 9355 - 113th St. N, #7709, Seminole, FL 33775(727) 210-2350www.caahep.org

Graduates are able to sit for examinations administered by the American Registry of Diagnostic Medical Sonographers (ARDMS)

Admissions Information

Criteria

Applicants are evaluated on the basis of the following criteria:

Due to the high volume of applications for the limited seats in this program, priority is given to applicants with the strongest academic performance. The best qualified applicants are reviewed for admission and invited to interview after the January 31, 2025 priority deadline.

Requirements

To be considered for admission, the following items must be submitted to the Admissions Office:

  • NMC undergraduate application
  • Official high school transcript
  • Official GED test scores, if applicable
  • Official transcripts from all colleges attended

Deadlines

Prospective students may apply anytime and are accepted from deadlines throughout the year. Applications will be reviewed upon receipt, and students will be notified of their application status by postal mail, email or phone.

Starting Term - Fall 2025

Priority Deadline - 1/31/2025

Standard Deadline - 7/11/2025

Costs & Financial Aid

NMC is committed to helping you find every avenue to finance your education. View the Tuition by Program & Degree page for a comprehensive list of all fees.

Cost Per Credit Hour

$623

NMC Scholarships

NMC Scholarships consist of funds generously provided by the Methodist Hospital Foundation to assist our students.

Student Grants or Loans

Visit our Financial Aid page to learn more about what's available and how to apply.

Employee Education Benefits

Employees of Methodist Health System can find details on the MHS Intranet.

External Scholarships

Visit our Scholarships page to learn more.

Calculate Your Net Price

Nebraska Methodist College Net Price Calculator.

Curriculum

The program requires a minimum of 128 credit hours. All students are required to complete specific coursework. This list should only be used as a curriculum guide. Course listings and required curriculum are subject to change.

Included within this list is the Educated Citizen Core Curriculum. All students seeking to complete an undergraduate degree at Nebraska Methodist College must complete this set of Arts & Sciences requirements.

Included within this list is the Educated Citizen Core Curriculum. All students seeking to complete an undergraduate degree at Nebraska Methodist College must complete this set of Arts and Sciences requirements.

All students will be responsible for creating, logging, & tracking their own modality procedures on the ARRT.org website. This information will be used for ARRT post primary application. All students will need to become familiar with the requirements for their chosen modality.

First year - First Semester

BIO 225
HUMAN ANATOMY & PHYSIOLOGY I
DETAILS
This course will provide foundational concepts for further study and understanding of the human body as it relates to healthcare related disciplines. Terminology that is specific to the medical field is introduced. Basic principles of chemistry, physics, embryology, developmental biology, and histology are reviewed/introduced. Students are introduced to the eleven body systems. This course focuses on articulations and the integumentary, nervous, skeletal, and muscular systems. Laboratory experience will include a multi-modal approach and will include cadaveric study. 

COM 101
ENGLISH COMPOSITION
DETAILS
This course provides instruction and practice in writing, with emphasis on the recursive processes of generating, drafting, revising and editing. Students develop skills in producing and evaluating written communications in private and public contexts.

COR 101
EDUCATED CITIZEN 101
DETAILS

DMS 103
SONOGRAPHIC EXPERIENCE
DETAILS
In this course students will gain a working knowledge of pediatric sonography and neurosonography. Anatomy, pathology, and sonographic correlation will be covered for organs/structures related to the genitourinary system, gastrointestinal system, central nervous system, neck, thorax, musculoskeletal system, and neonatal brain.

PSY 101 or 215
Introduction to Psychology or Lifespan Development
DETAILS

PSY 101     INTRODUCTION TO PSYCHOLOGY This course offers students an engaging introduction to the essential topics in the field of psychology. Throughout this scientific study of human behavior and the mind, students will survey and gain insight into the history of the field of psychology, as well as explore current theories and issues in areas such as wellness, emotion, cognition, motivation, perception, consciousness, social and personality, and memory.

PSY 215     LIFESPAN DEVELOPMENT The Lifespan perspective involves several basic contentions: development is life-long, multidimensional, multi-directional, plastic, historically embedded, multi-disciplinary and contextual. Three imperative developmental issues are explored: maturation and experience, continuity and discontinuity and stability and change. Students study how humans develop and how they become who they are.

SCI 116
MEDICAL TERMINOLOGY
DETAILS
This course will introduce students to terminology used in the healthcare professions. The origins of medical terms will be studied with an emphasis placed on understanding the suffixes, prefixes, combining forms, and root words used in healthcare terminology to be able to properly communicate issues related to their profession using appropriate terminology.

First year - Second Semester

BIO 226
HUMAN ANATOMY & PHYSIOLOGY II
DETAILS
This course will continue to apply foundational concepts of the human body as they relate to healthcare related disciplines. The structure and function of the special senses, along with the endocrine, circulatory, lymphatic, respiratory, digestive, urinary, and reproductive systems are explored in this course. Laboratory experience will include a multi-modal approach and will include cadaveric study.

Prerequisite: BIO 225 
Prerequisite or Corequisite: CHE 101

HUM 219
MEDICAL LAW AND ETHICS
DETAILS
This course is an introduction to the fundamentals of medical laws, ethical principles and bioethics for the healthcare practitioner. The application of these fundamental principles will be applied using current medical-legal issues and bioethical dilemmas of today. The course is designed to improve the student’s ability to critically think and make sound decisions that are in alignment with professional ethics and values, integrity and judgment. The course will include such areas as confidentiality, privacy, consents, responsible practice, professionalism, bioethical dilemmas, and key legal aspects that influence the healthcare practitioner.

MAT 120
COLLEGE ALGEBRA
DETAILS
This course provides an advanced study of algebraic methods and prepares students for further studies in mathematics and physics. Content of the course starts with a review of basic concepts of algebra, and then it intensifies the study of the following topics: equations, inequalities, polynomials, exponents, logarithms, and the concept of functions and their graphs.

Prerequisite: MAT 110

PHY 101
PHYSICS I
DETAILS
This course will introduce learners to an overview of fundamentals of physics by exploring the various phenomena of physical science. The focus of this course will include kinematics, Newton’s Laws, momentum, work and energy, sound and light waves, thermodynamics, static electricity and electric circuits. This lab includes experiments relevant to the material explored in Physics I.

Prerequisites: MAT 110

Second year - First Semester

DMS 140
APPLIED SECTIONAL ANATOMY
DETAILS
This course provides an introduction to the basics of cross-sectional anatomy of the head, neck, chest, abdomen andpelvic anatomy with emphasis on structures visualized in diagnostic medical sonography, computerized tomography(CT), magnetic resonance imaging (MRI), and nuclear medicine. The anatomy will be evaluated in multiple planes.

DMS 150
Multispecialty Anatomy and Image Optimization
DETAILS

This lab will provide the students with hands-on experience in the use of diagnostic medical sonography equipment. Students will learn how to properly hold and manipulate the transducer, properly adjust equipment settings to create diagnostic images, identify image orientation as it relates to various scanning planes, and to properly set Doppler controls.

Prerequisites: Program prerequisites completed

DMS 206
SONOGRAPHIC PHYSICS I
DETAILS
This course will introduce fundamental sonographic theory including terminology, equipment, basic transducer construction and function, introduction to Doppler, and adjusting system controls for image acquisition. This course will cover beginning concepts in sonographic physics including pulsed sound parameters, intensities, and interactions of sound with media, range equation, transducers, sound beams, and axial and lateral resolution.

DMS 209
SONOGRAPHIC SEMINAR I
DETAILS

This course facilitates the student’s entry into diagnostic medical sonography. Students explore personal and professional values in relation to the healthcare setting. Students acquire skills to assist them with time management, building critical thinking skills, and the ability to professionally communicate in the field of sonography.

HPS 100
HEALTHCARE FUNDAMENTALS I
DETAILS

This course serves as an overview for all members of the health care delivery team. The focus is placed on the basic skills needed to perform quality patient care, relationships with other health care team members, patient safety and scope of practice for each profession, vital signs, HIPAA, infection control, invasive procedures and self-care. 

HUM 220-279
Humanities Elective
DETAILS

SCI 206
PATHOPHYSIOLOGY/PHARMACOLOGY
DETAILS
This survey course begins with a major focus on cellular function and pathology, including inflammation, infection, immune response, metabolism, and fluid disequilibria. These concepts serve as the foundation for the course as alterations in various bodily functions are examined. Alterations in body fluid and electrolyte homeostasis, fluid acid/base balance, gastrointestinal, urinary, respiratory, cardiac, endocrine, and neurological functions are emphasized. The student will be introduced to pharmacological principles and utilize critical thinking to explore the relationship between those concepts and commonly used classes of medications.

Prerequisites: SCI 200

Second year - Second Semester

COR 201
EDUCATED CITIZEN 201
DETAILS

DMS 221
ABDOMINAL ULTRASOUND I
DETAILS
This course will study the clinical applications of abdominal sonography which will include positioning and scanning protocol. Anatomical structures to be covered will include: abdominal vasculature, liver, gallbladder and biliary system, pancreas, spleen, and urinary tract. Invasive procedures and small parts protocol will also be discussed. Interpretation and critique of normal anatomy with correlation of clinical, didactic and image information will be presented. Lecture will coincide appropriately with DMS 223 to facilitate a simultaneous understanding of didactic and laboratory application.

Prerequisites: DMS 140, DMS 206, DMS 209

DMS 223
ULTRASOUND LAB I
DETAILS
This course will focus on applying ultrasound as a diagnostic tool for evaluating the abdomen, female pelvis and 2nd trimester fetus and all related structures. Coursework will include techniques for proper identification and representation of the normal anatomical structures as well as demonstrations and discussion on the proper scanning techniques and positioning utilized to obtain optimum diagnostic images. Lab will coincide appropriately with DMS 221, DMS 228 and DMS 281 to facilitate a simultaneous understanding of didactic and laboratory application.

Prerequisites: DMS 140, DMS 206, DMS 209

DMS 228
GYNECOLOGIC ULTRASOUND I
DETAILS
This course is designed to explore the fundamentals of evaluating the non-gravid female pelvis as it relates to ultrasound.The primary focus of this course will be a comprehensive overview of the normal anatomy, physiology and ultrasoundevaluation of the female pelvis and reproductive system.

Prerequisites: DMS 140, DMS 206, DMS 209, SCI 206

DMS 281
OBSTETRICS ULTRASOUND I
DETAILS
This course will provide an in depth study of the specific anatomy and sonographic anatomy of the developing embryo and fetus from first -third trimester necessary for the clinical practice of obstetric sonography.

DMS 288
HIGH RESOLUTION STRUCTURES
DETAILS
This course focuses on the anatomy, physiology, pathology and pathophysiology of the neck, thyroid, breast, scrotum, superficial aspect of the extremities, musculoskeletal. Coursework will familiarize the student with scanning techniques and protocols to evaluate normal sonographic appearance, abnormal sonographic appearances, and ability to identify specific pathological conditions as demonstrated on sonographic images. Correlation of pertinent clinical history, symptoms, clinical laboratory tests and other diagnostic procedures will be emphasized.

Prerequisites: DMS 221, DMS 228, DMS 272, DMS 281, DMS 306

DMS 306
SONOGRAPHIC PHYSICS II
DETAILS

This course continues where DMS 206 leaves off. The following sonographic principles are covered: real-time imaging, pulse echo instrumentation, displays and image processing, dynamic range, harmonics and contrast agents, hemodynamics, Doppler principles, Doppler optimization, artifacts, quality assurance and bioeffects. 

Prerequisites: DMS 206

Second year - Third Semester

COM 255 or 262
BEGINNING HEALTHCARE SPANISH OR AMERICAN SIGN LANGUAGE BASIC SKILLS
DETAILS

Beginning Healthcare Spanish

This course will provide basic knowledge of the Spanish language and Latino culture, and emphasize the importance of this knowledge as it relates to healthcare in the United States. The student will demonstrate an ability to express ideas and thoughts in Spanish using both verbal and nonverbal communication skills in a culturally competent manner. In addition, the student will develop strategies to continue acquiring proficiency with the Spanish language beyond this course.

OR

American Sign Language Basic Skills

This course presents practical communication skills needed for health professionals working with deaf clients. Everyday communication is the centerpiece of every lesson. Topics revolve around sharing information which is vital in the healthcare industry. Grammar is introduced in context, with an emphasis on developing question and answering skills that would occur between healthcare professional and patient. Students will learn conversational strategies to help maintain a conversation with deaf patients. Students will appreciate the diversity of deaf people and their culture. Interaction activities will allow students to rehearse what they’ve learned.

DMS 276
ULTRASOUND LAB II
DETAILS
This course will focus on applying ultrasound as a diagnostic tool for evaluating the abdomen, small parts, 2nd trimester fetus and all related structures. Coursework will include techniques for proper identification and representation of the normal anatomical structures as well as demonstrations and discussion on the proper scanning techniques and positioning utilized to obtain optimum diagnostic images. Lab will build on the principles of DMS 223.

Prerequisites: DMS 221, DMS 223, DMS 228, DMS 281, DMS 305

DMS 280
CLINICAL PRACTICUM I
DETAILS
This course is designed to provide hands-on experience in the clinical setting and to familiarize the student with the daily activities in an Ultrasound Department.  By working closely with the clinical instructors and the staff technologists, the student will actively participate in exams, patient care, and everyday maintenance of the ultrasound department.  The clinical rotations will help the students develop skills in abdominal, OB/GYN and high resolution sonography.

Prerequisites: DMS 221, DMS 223, DMS 228, DMS 272, DMS 281, DMS 305

DMS 321
ABDOMINAL ULTRASOUND II
DETAILS
A continuation of Abdominal Ultrasound I, with emphasis on pathology seen in the abdominal system of the adult and pediatric patient. Students will become familiar with the clinical symptoms, lab values associated with specific pathologies. Abnormal case studies will be reviewed.

Prerequisites: DMS 221, DMS 223L

HUM 250-259
HUMANITIES: HISTORICAL PERSPECTIVES
DETAILS
Students critically analyze the impact of history on contemporary society. Historical methods of inquiry inform students' perspectives on societal and institutional development. Most undergraduate students must take one course from this group. HUM 255 HISTORICAL PERSPECTIVES HUM 256 THE HISTORY OF WESTERN MEDICINE HUM 257 U.S. HISTORY: PAST, PRESENT, AND PROMISE: A SEARCH FOR THE TRUTH BY CHALLENGING THE PRESENT & DEMANDING A NEW FUTURE HUM 258 WORLD HISTORY TO 1800 HUM 259 HISTORY OF SCIENCE: THE CREATION OF A BIOMEDICAL WORLD

Third year - First Semester

DMS 285
CLINICAL PRACTICUM II
DETAILS
As a continuation of Clinical Practicum I, the students will receive hands-on experience in a variety of settings with exposure to a vast array of ultrasound systems.  By working closely with the clinical instructors and the staff technologists, the student will more actively participate in exams, patient care, and everyday maintenance of the ultrasound department. The clinical rotations will help the students continue to develop their skills in abdominal, OB/GYN and high resolution sonography.

Prerequisites: DMS 276, DMS 280, DMS 288 

DMS 328
GYNECOLOGIC ULTRASOUND II
DETAILS
This course is a continuation of DMS 228, Gynecologic Ultrasound I.  The primary focus of this course will be a comprehensive overview of pathology related to the female pelvis, particularly the uterus, fallopian tubes and ovaries.

Prerequisites: DMS 276, DMS 280, DMS 288

DMS 360
Clinical Reasoning
DETAILS
The focus of this class will be on sonographic anatomy, developing a clinical hypothesis, and establishing a differential diagnosis for commonly encountered sonographic pathology in Abdomen, Obstetrics, GYN and small parts.  Students will be called upon to integrate information from Sonographic Anatomy and Interpretation, Physics and Instrumentation, Pathophysiology, and Anatomy-Physiology.

Prerequisites: DMS 221, DMS 228, DMS 281, DMS 288, DMS 321

DMS 381
OBSTETRICS ULTRASOUND II
DETAILS
A continuation of Obstetrics Ultrasound I, this course will place emphasis on fetal anomalies that can occur across the gestational period. Importance will be placed on identification of the pathological processes, sonographic appearances, correlation with the clinical history and diagnostic testing or procedures, and clinical management options. Topics will include, but are not limited to: maternal diseases and potential fetal consequences; multiple gestation; management of high risk pregnancies; assessment of fetal well being; role of Doppler; interventional procedures; and advanced technologies currently used in obstetrics. Abnormal case studies will be reviewed.

WMI 345
ADVANCED BREAST IMAGING
DETAILS
This course is designed to explore the multiple topics in the area of breast imaging. The primary focus of this course will be a comprehensive overview of the anatomy and physiology of the breast, multiple imaging modalities focused on breast sonography, as well as benign and malignant conditions involving the breast. 

Third year - Second Semester

DMS 307
SONOGRAPHIC SEMINAR II
DETAILS
Students will be required to take an ARDMS specialty examination (Abdomen or OB/GYN) as part of this course prior to graduation. This course will assist students in the transition from student sonographer to professional sonographer, including ARDMS registry exam preparation. Additional topics such as resume writing, interview and negotiation skills, understanding benefits and different avenues of the sonography career ladder are also discussed.

Prerequisites: Successful completion of all program DMS and EC Core Coursework prior to the beginning of the course.

DMS 352
VASCULAR IMAGING
DETAILS

This course is designed to present the most common vascular ultrasound examinations conducted in a radiology setting. The primary focus of the course is a comprehensive overview of the anatomy and physiology of the carotid and lower extremity venous systems. The lab component of this course allows students to become familiar with carotid and lower extremity venous scanning protocols.

Prerequisite: DMS 285

DMS 380
CLINICAL PRACTICUM III
DETAILS
A continuation of Clinical Practicum II, the students will receive hands-on experience in a variety of settings with exposure to a vast array of ultrasound systems. By working closely with the clinical instructors and the staff technologists, the student will more actively participate in exams, patient care, and everyday maintenance of the ultrasound department. The clinical rotations will help the students continue to develop their skills in abdominal, OB/GYN and high resolution sonography.

Prerequisites: DMS 276, DMS 285, DMS 328, DMS 360 

HUM 220-229 or 270-279
Humanities Elective: The Arts or Human Connection
DETAILS

SSC 325
APPLIED ANALYSIS OF RESEARCH
DETAILS
Evidence-based practice is an important component of effective clinical management. This course allows students to develop skills in applied statistics and research while learning to critically examine healthcare information from a variety of sources, including but not limited to professional journals, governmental reports and public media.

Third year - Third Semester

COR 301
EDUCATED CITIZEN 301
DETAILS

DMS 311
FETAL ECHOCARDIOGRAPHY
DETAILS
This course serves as an introduction to the ultrasonographic cross-sectional anatomy and physiology of the fetal cardiac and circulatory system, with emphasis on recognition of the appearance of normal fetal cardiac anatomy, and cardiac pathology or defects via sonographic images and clips, knowledge of differential diagnosis of various fetal cardiac pathology, and general understanding of clinic protocols and standards regarding cardiac imaging.

Fourth year - First Semester

DMS 322
PEDIATRIC/NEUROSONOGRAPHY
DETAILS
In this course students will gain a working knowledge of pediatric sonography and neurosonography. Anatomy, pathology, and sonographic correlation will be covered for organs/structures related to the genitourinary system, gastrointestinal system, central nervous system, neck, thorax, musculoskeletal system, and neonatal brain.

Prerequisites: DMS 321

HUM 210 or 213
Introduction to Ethics or Principles and Practice of Ethics
DETAILS

Students must choose to take either:

HUM 210 INTRODUCTION TO ETHICS:

Introduction to Ethics introduces students to theories and practices of individual, communal and societal obligations. Moral inquiry in the course proceeds from a philosophical basis.

HUM 213 PRINCIPLES AND PRACTICE OF ETHICS:

This course introduces students to theories and practices of individual, communal and societal obligations. Moral inquiry in the course proceeds from a philosophical basis, with an emphasis on varied professional codes of ethics in healthcare disciplines. Students will explore codes of ethics and how they relate to traditional Western philosophies.

SSC 345
Professional Writing For Imaging Journals
DETAILS

Fourth year - Second Semester

COR 401
EDUCATED CITIZEN 401
DETAILS

COR 402
EDUCATED CITIZEN 402: Seminar
DETAILS

WMI 326
BEREAVEMENT AND LOSS FOR THE WOMEN'S HEALTH PROFESSIONAL
DETAILS
This is a specialized course in the study of grief and bereavement for healthcare professionals focusing specifically on women's health. Students will gain insight to their own personal losses and how this impacts their professional practice. Topics include experiences of grief across the lifespan, cultures, gender and spiritual differences. Students will also learn about how they can support those grieving through verbal, non-verbal communication and creating memories. Students will be able to identify local and national resources they can share with their patients. Finally, students will reflect on self-care strategies to help reduce burn out.

WMI 423
TOPICS IN INFANT, ADOLESCENT, AND WOMEN'S HEALTH
DETAILS
Students will gain an expanded understanding of maternal and child health from a public health perspective. Using current issues such as infant mortality, maternal morbidity, adolescent sexual health and more, major concepts and theories in MCH will be explored and future implications discussed.

Meet the Faculty

Our Diagnostic Medical Sonography faculty are highly experienced and credentialed in their own fields, giving you constant real-world insight you can use.

While any instructor can recite from a textbook, ours go a step further and draw from vast personal experience. Instructors here care as deeply about their students as they do the subject matter and it shows.

Meet the Faculty

Additional information

Program Information

  • Multiple points of entry:
    • On campus bachelor of science degree option (4 year degree)
    • Degree completion for associate degree graduates -- those who are ARDMS or RT registered and looking to go on for their bachelor degree.
  • No previous coursework required; students can apply directly out of high school.
  • Courses delivered in a hybrid format: on campus and online.
  • Transfer students who are ARDMS registered will receive credit for prior learning based on specific credentials.
  • Opportunity to select additional elective coursework and clinical experiences related to Neonatal Neurosonography, Fetal/Pediatric Echocardiography, Adult Echocardiography and Vascular Technology.

What is women's medical imaging?

It is a specialty within diagnostic medical sonography that focuses on the unique needs of women, including:

  • High risk pregnancy
  • Genetics
  • Infertility
  • Breast cancer
  • Women's health issues

Technical Standards

The purpose of this policy is to determine the physical and emotional abilities of a student in the Department in compliance with Section 504 of the Rehabilitation Act of 1973 and the Americans with Disabilities Act of 1991.

Policy:
It is your responsibility to understand the duties, responsibilities, skills and abilities required of your chosen program/profession. In addition to the technical standards as described above, please review the information regarding Diagnostic Medical Sonography at the O*NET website.

Procedure:

  1. Behavioral and Social Skills - Possess qualities of compassion, integrity, empathy and interpersonal skills. Possess emotional health necessary to effectively complete professional responsibilities.
  2. Communication - Read, write, speak, hear, and observe patients to effectively communicate the patient's condition and interact with the patient and other healthcare individuals.
  3. Integrative and Quantitative Skills - Problem solve utilizing computation, synthesis, and analysis. Visualize and analyze three dimensional relationships.
  4. Motor and Functional Abilities - Perform therapeutic and diagnostic procedures.
    *Sonography students must assist with moving and lifting patients and equipment of up to 50 lbs or more, up to 50% of the time. Visual abilities are necessary for viewing the ultrasound screen 85% of the time. This is adapted from Methodist Health System Performance Development Plan -Job Description for the sonographer
  5. Observation - Use instruments requiring sight, e.g., ultrasound and radiographic equipment, health assessment tools and devices, i.e. blood pressure cuff, stethoscope,etc. Make observations and evaluations. Observe results of treatment and reactions.