CC
Chief Complaint
Segment
Line between two wave forms
P-wave
Atrial Depolarization
How many 1mm boxes are in a 6 second Rythm strip?
30 one millimeter boxes
The SA node represents which waveform on the ekg?
Only the P-wave
What is the reading you can get from the RR interval?
Ventricular Pulse
What is the primary stage of Hemolisis?
Vascular phase and platelet phase together
What is Electophoresis?
Analyzation of the chemical components of blood e.g. hemoglobin, serum, urinem cerebrospinal fluid based on electrical charge.
Positive testing for occult blood in a stool sample turn which color?
Turns Blue on a positive test for occult blood in feces.
The stages of Hemostasis:
1. Vascular 2. Platelet Phase 3. Coagulation Phase 4. Fibronolysis
Blood Vessels
Aorta, arteries, arterioles, capillaries, venues, veins, superior and inferior vena cavae.
Outer connective tissue layer of a blood vessel
Tunica adventitia
Inner endothelial tissue layer of a blood vessel
Tunica Intima
The inner smooth layer of a blood vessel
Tunica media
The standards of right and wrong in a medical setting
Code of Ethics
What do you find in capillaries?
A mixture of venous and arterial blood is found
The average adult has how many liters of blood?
5-6 liters
What is the percentage of water in blood?
92%
Percentage of plasma in blood
55%
Percentage of Formed Elements in the blood
45%
99% of formed elements in blood
RBC's or Erythrocytes
Where you find Hemoglobin
RBC's
Where do all blood cells originate?
Bone Marrow
How many RBC's per microliter of blood
4.2-6.2 million
What is the second most numerous WBC?
Lymphocyte with 20-40%
Their numbers increase in intracellular infections and TB
Monocytes
Their numbers increase in bacterial infections and often are first on scene
Neutrophils
These WBC's play an important role in viral infection as well as in immunity.
Lymphocytes
Number of leukocytes for average adult per micrometer
5000-10000
Leukopenia
Decrease in WBC's seen with viral infection and leukemia
Comprises 3-8% of wbc or leukocytes
Monocytes
Largest in size of the leukocytes
Monocytes
Carries Histamine
Basophil
Injury to a blood vessel that causes it to constrict, slowing the clot of blood
Cascular phase of hemostasis
Preferred site for venipuncture
Antecubital fossa
Test used to evaluate the intrinsic pathway and monitor heparin therapy
APTT also know as PTT
Test used to evaluate the extrinsic pathway and also used to monitor warfarin therapy
PT
Fibrinolysis
Breakdown and removal of a clot
Converts the temorary platelet plug into a stable fibrin clot
Coagulation phase
2nd choice vein for venipuncture most often the only one palpatable in an obese pt
Cephalic vein
Antiseptics used in Phlebodtomy
70% isopropyl alcohol pads most common, provolone iodine for bc, s and chlorhexidine gluconate for patients that are allergic to betadine/ iodine
Length of needle commonly used in venipuncture
1 ince (up to 1.5")
Guage of needle that can cause hemolysis
Smaller than 23 guage
Average gauge of needle used for drawing blood
21-22
3 skills of the phlebotomist
social, clerical, technical
Analytical errors during collection of blood
extended tourniquet time, hemolysis, wrong order of draw, failure to invert tubes, faulty technique under filling tubes
Analytical errors before collection of blood
Patient misidentification, improper time, wrong tube, not fasting, exercise (cortisol levels), PT posture, poor coordination with other treatments, improper side prep, medication interference
Analytical errors after blood collection
Failure to separate serum from cell (glycolisis), improper use of serum separator (not inverting tubes or not spinning tubes) delays in processing, exposure to light, improper storage conditions, dimming clots
Fistula
Permanent surgical connection between an artery and a vein, never used for venipuncture
Edima
Accumulation of fluid in tissue
Thrombophlebitis
Inflammation of a vein with a clot formation
Explanation of Hemoconcentration
The increase in proportion of formed elements to plasma caused by leaving on the tourniquet for more than two minutes
Consequence of insufficient pressure applied after withdrawal of needle
Thrombus
additives in green top tube
heparin, sodium, litium, ammonium
Why is the green top tube never used for hematology
Green tops additive heparin interferes with the Wright's stained blood test
Common tests for the lifht blue sodium citrate tube
Coagulation studies, PT (extrinsic, warfarin) APTT, PTT (intrinsic, heparin) TT, BT, FDP
Common tests for the lavendar edta tube
CBC, differential or diff., ESR, sickle cell screening
Common tests for this color tube are chemistry tests performed on plasuma such as Ammonia, carboxyhemoglobin and STAT electrolytes
Green top tube (heparin) Tests
How long does it take for blood to clot by normal coagulation process in the red top tube?
30-60 mins
The primary purpose is to provide reliable data about a patients health status by ensuring the accuracy of a test while detecting and eliminating error
What is quality control
Common test for the red topped tube
Serum chemistry tests, serology tests, blood bank (glass only)
Order of draw for cappilary specimens
lavender first, then tubes with other additives, then tubes with out additives
Antiseptic not used on a dermal puncture site
Betadine (because it interferes with several tests like bilirubin, uric acid, phosphorus and potassium
For which procedure would you warm the site for a minimum of 3-4 minutes to increase blood flow?
dermal punctures (heel sticks)
Which are the preferred sites for dermal punctures
the distal segment of the third or fourth finger of the non-dominant hand
heel sticks are performed on which patients?
infants less than 1 year old
Where on the foot is the dermal puncture made on patients less than a year old
the medial and lateral areas of the plantar surface of the foot
dermal puncture is made in
the fleshy portion of the finger slightly to the side of the center perpendicular to the lines of the fingerprints
What will occur if you puncture the heel too deep? more than 2 mm
osteomyalitis
What are the identification requirements for blood bank
Pt's full name and DOB, hospital id # or ssn for outpatient, date and time of collection as well as the phlebotomist's initials
This section of the lab uses serum to analyze the presence
Serology (immunology) Section
When checking for hormones in urine when do you collect the urine sample
first voiding in the morning
Which urine specimen provides the clearest, most accurate results?
Clean catch midstream specimen
Which urine sample requires aseptic technique?
Clean catch specimen
Examination of urine consists of
physical, chemical, microscopic
Physical examination of urine consists of
colume (adequate for testing, observing color and appearance, odor, specific gravity
What amount of urine must you have to be sufficient for analysis?
25ml
What is the normal range of specific gravity of random collection
1.005-1.030
normal range of specific gravity of urine in adults with normal diet and fluid intake
1.015-1.025
Microscopic examination of urine requires this amount
10-15ml
Urine Specific gravity
The ratio of weight of a given colume of urine to the weight of the same volume of distilled water at a constant temperature
Glycosuria
presence of glucose in the urine
Symptoms of patients with diabetes mellitus
glycosuria, polyuria, and thirst
A urine pH of what is considered neutral?
7.0 pH
the copper reaction test is used for what?
screening for glucose in urine
The presence of leukocytes in urine is an indicator for what?
bacteruria or UTI
Urine Screening for UCG or HCG
Pregnancy Test
HIPPA is for?
Patient Confidentiality
The four elements of Negligence
Duty, duty of care, derelict= breach of duty of care, direct cause, damage
Tort
Wrongful act that results in injury to one person to another
Examples of Tort
Battery, invasion of privacy, defamation of character
Defamation of character by written statement is considered
libel
Consists of injury to another person's reputation , name or character through spoken (slander) or written (libel)
Defamation of character
unpriveleged touching
Battery
The release of medical records with out the patient's knowledge or permission
Invasion of privacy
Good Samaritan Law
Rendering first aid within the scope of knowledge by a health care worker with out fear of being sued for negligence
Hypothalamus
regulates and maintains body temperature
Functions necessary for life
heart function, blood pressure, respiration, temperature
Rectal Temperature range in celsius
37.0 -38.1 C
Oral temperature range in Fahrenheit
97.6-99.6 F
Axillary temperature range in celsius
35.9-37.0C
Tympanic temperature range in F and C
98.6 F and 37C
Intermittent fever
Fluctuating fever that returns to or below the baseline then rises again
Remittent Fever
Fluctuating, remains elevated and does not return to baseline
Continuous Fever
remains constant above baseline, does not flucuate
Rectal temperature is not taken from the following patients
Patients with heart disease
WHen taking axillary temerature how long should it be taken
5-10 mins or as required by office policy
Pulse is taken where and how long
radial for 30sec x2, if tachy or brady take it 1 minute
Explain blood pressure
measurement of amount of force blood excertes on peripheral artery walls
BP cuffs too short and narrow can give false reading of what?
Hypertension
Taking BP hearing two consecutive beats gives which reading
Systolic
Patient laying on back with knees flexed, soles of feet on bed
Dorsal recumbant
This position is used to promote drainage or ease of breathing
Fowler's
This position is used for examination of the pelvic organs
Dorsal Lithotomy
Prone position is used for
used to examine back and spine
patient lays on his/her stomach with head turned to one side for comfort
prone position
Patient in on left side with the right knee flexed against abdomen
Sim's position
Patients with leg injuries or arthritis can not assume this position
Sim's position
This position is usually used for taking rectal temperature
Sim's position
This position is usually used for rectal or vaginal examination
Knee Chest
This position is used for surgical procedures of pelvic abdomen and also for shock treatment
Trendelenburg
Never leave the patient alone in the room when he/she is in this position
Knee Chest
This position is used for surgical procedures of pelvic and abdomen and also for shock treatment
Trendelenburg
If skin or eyes come in contact with chemicals wash area with water for ?
5 minutes
MSDS
Material Safety Data Sheet
What are the symptoms of shock
plale cold clammy skin, blank stare, rapid weak pulse, fast shallow breathing
First aid for shock
Open airway, call assistance, position head lower, control bleed if any, keep warm
Modes of transmission
contact (direct or indirect) droplet, airborne, common vehicle, vector
What is the least expensive and most available disinfectant for surfaces
1:10 bleach solution
Define surgical asepsis
All microbial life, pathogen and non pathogens are destroyed
What is used at 250-254F, 15 pounds of pressure for 20-40 minutes
Autoclave
Used for instruments that easily corrode
dry heat sterilization
What is the most important means of preventing the spread of infections?
Handwashing
PPE includes?
mask, goggles, face shields, respirator
What defines standard precautions?
All patients are presumed to be infective for blood borne pathogens
This is an infection control method designed to prevent direct contact with blood or other body fluids
Standard precautions
This replaces universal precautions and body substance isolation
Standard precautions
Don gloves, face shields if danger of splashing, dispose of all needles with out recappiong into the sharps container
Standard Precautions
This is the second tier of precautions used when patient is contagious
Transmission based precautions
Define contact precautions
Reducing the risk of transmission of microorganisms direct or indirect
Special air handling and ventilation are required to prevent
Airborne diseases under Airborne Precautions
This is an emerging and important problem in the health care field
Latex Sensitivity
Every health care worker with this latex allergy should wear this
Medical alert bracelet
po
Per oral
pr
Per rectum/suppository
sl
sublingual under tongue
IM
Intramuscular
SQ
Subcutaneous
qd
every day
bid
twice a day
tid
three times a day
qid
four times a day
pc
post consumption/ after a meal
qhs
each night or at bed time
prn
as necessary or when needed
sig
from the latin, let it be labeled
The inner most layer of the heart
endocardium
a muscular hollow organ located in thoracic cavity between lungs
the heart
actually the inner visceral layer of the pericardium
Epicardium
the sac containing the heart
pericardium
serous fluid
prevents friction as the heart beats
recieves deoxygenated blood returning to the heart from the body
Right Atrium
recieves deoxygenated blood from the right atrium which it pumps to the lungs throguh the pumonary artery
Right Ventricle
receives oxygenated blood from the left atrium and pumps it to the body thru the aorta
Left Ventricle
The av valves
Tricuspid and Mitral (bicuspid ) valves
The Semilunar valves
Aortic and pulmonic
Valve located between the left atrium and the left ventricle
Mitral or bicuspid
Valve lovated between the right ventricle and the pulmonary trunk
pulmonic valve
heart sounds produced by closure of the valves
murmors
caused by diseases of the valves or other structural abnormalities
Murmors
First heart sound due to the closure of the mitral and tricuspid valves
S1 in the upper chambers or the atria
S2 in the ventricles
second heart sound due to the closure of the aortic and pulmonic valves
arteries supplying the heart
right and left coronary from the aorta
Arteries supplying the heart
right and left coronary from the aorta
The ans or autonomic nervous system is subdvided into
sympathetic and parasympathetic nervous system
The SP or sympathetic nervous system affects
both, the atria and the ventricles by increasing heart rate conduction and irritability
The pns or parasympathetic nervous system affects
atria only by decreasing heart rate, conduction and irritability
Automaticity
ability of the cardiac cells to initiate own electrical impulses without outside stimulation
Excitability or irritability
ability of cardiac cells to respond to external stimulus
Contractility
ability of cardiac cells to shorten (muscle contraction) in response to electrical stimulus
Digitalis, dopamine, epinephrine
Drugs that increase the contractility of the heart
Results in myocardial relaxation
repolarization
Consists of anterior, middle and posterior divisions that distribute electrical impulses by SA to AV node
Internodal pathway
This fires at 20-40 bpm
Purkinje fibers
limb leads consist of
3 bipolar and 3 augmented leads
These record electrical potentials in the frontal plane
Lead I, Lead II, Lead III and the chest leads
On Lead III, which is the positive lead
the left leg is positive
Which limb is always the ground
right leg
Waveform
movement away from the isoelectric line either positive or negative
Interval
waveform plus a segment
Complex
Several waveforms
The normal P wave in standard and precordial leads does not exceed
0.11s in duration or 2.5 mm in height
The vertical axis on the ekg paper measures
Amplitude or voltage
J (RST) junction
point at which QRS complex ends and the ST segment begins
ST segment
from J point to the onset of the T wave
Normal indication for a stress test
Evaluation of a patient withchest pain and a normal ekg, arrythmia, monitoring a pt, with a recent MI
The percentage of the target heart rate during a stress test that makes it valid
85%
Hematocrite is made up of
hemoglobin x 3
Define hematocrit
The percentage by colume of packed red blood cells in a given sample of blood after centrifugation
Opposite of anemia
polycythemia
When taking a pharmacologic stress test, it is concluded when
85% of the target rate is achieved
Drugs used for a pharmacologic stress test
adeosine, dipyridamole, dobutamine
Ectopic Rythms
electrical impulses originating from somewhere else but the SA node
Pre-excitation Syndrome
Electrical impulses of the heart bypass the normal pathway and instead go down an accessory shortcut
Conduction Block
electrical impulses go down but encounter blocks and delays
Indication for temination of a stress test
SOB (shortness of breath), chest pain, dizziness, blood pressure abnormalities
Ischemia
decrease in amount of blood flow
What is the hallmark of a infarction
The presence of abnormal Q waves
List some cardiac markers
Triponin, CK, LDH, SGOT, AST
What is a negative holter?
A negative holter will have no significant arrhythmias or ST changes
How long is a holter monitor worn?
24 hours or longer
Why is a holter monitor done?
To rule out arrhythmia's or ischemia
How many electrodes are on a holter monitor
5
A positive holter is one that recorded at least one or more of these abnormalities
Tachy or bradycardia, ST segment elevation or depression, pauses
When is the event monitor used?
Only when symptoms occur
List drugs givenfor acute MI
Oxigen, Epinephrine, Isoproterenol, Dopamine (Intropin) Beta blocker (olol), Lidocaine, Verapamil, Digitalis, Morphine, Nitroglycerin
What is a powerful smooth muscle relaxant with the side effect of headache
Nitroglycerin patch or SL
Digitalis does
increases the force of cardiac contractions as well as cardiac output, tocicity in 20% of patients
Butterfly
Winged infusion set
What is the most important task of a phlebotomist
patient ID
With the bevel upward insert the needle at which angle?
15-30 degrees
Prandial
Fasting
What is important to do first after dermal puncture?
Wipe away the first drop
Timed specimens
Hormone levels, blood levels of medications, monitor PT condition E.G. Hemoglobin level *internal bleeding )
While administering a OGTT it is important to take what with each sample
Urine Sample
When are OGTT scheduled to begin?
0700-0900 7-9am
The two hour postprandial test is used for?
evaluation of diabetes mellitus
The OGTT test is used for ?
Diagnosing diabetis mellitius and evaluating patients with frequent low blood sugar
The 3 hour OGTT is used to test for
To test for hyperglycemia
The 5 hour OGTT is used for
To test for hypoglycemia, for disorders of carbohydrate metaolism
PKU
Tests for babies and to detect phenylketouria, a genetic disease that causes mental retardation and brain damage
Cold Agglutinins
Antibodies produced in response to atypical pneumonia must be kept at 37c
ABG, AMMONIA, lactic acid, pyruvate, parathyroid test handling
Chilled in crushed ice and water mixture
Billi
Bile
Which blood tests can NOT be done using dermal puncture
ESR, BC
You have the right to caring staff who believe your reports of pain
Example of the patient bill of rights for pain management
Method of taking pulse used on children and patient with irregular heartbeat
Apical pulse
Orthopenia
Difficulty breathing when laying flat
Define Cheyne- Stokes
Regular pattern of irregular breathing rate
Medical Assistant role in the physical examination
Room prep, patient prep, assisting the doctor
Hazards
Physical, chemical , biological
This technique is not permitted in the lab
Never draw a pipette by mouth
Expresionless face and staring eyes are indications of
Shock
Agents are
Any infective microorganisms, viruses,fungi, bacteria, and parasites
Define common vehicle
Water, food, drinking from the same glass, kissing
What fires at 40-60 bpm
AV junction, bundle of HIS
Which are unipolar leads?
aVR, aVL, aVF
Whhich test is used to evaluate primary hemostasis
Bleeding time test
How long is the lifespan of a platelet?
9-12 days
When the vaccutainer method can not be used you would use
10-12ml Syringes
Which tube nmust be filled completely?
Light Blue sodium citrate tube to maintain a ratio of 9:1