NHA CCMA Study Guide, Nha certification study guide for CCMA

NHA CCMA Study Guide, Nha certification study guide for CCMA 1. Chief Complaint Definition - ANSWER The reason why the patient came to see the physician. 2. Chief Complaint Abbreviation - ANSWER CC 3. History of Present Illness Abbreviation - ANSWER HPI 4. History of Present Illness Definition - ANSWER This is an explanation of the CC to determine the onset of the illness; associated symptoms; what the patient has done to treat the condition, etc. 5. Past, Family and Social History Abbreviation - ANSWER PFSH 6. Past Medical History Definition - ANSWER Includes all health problems, major illnesses, surgeries the patient has had, current medications complete with reasons for taking them, and allergies. 7. Family History Definition - ANSWER Summary of health problems of siblings, parents, and other blood relatives that could alert the physician to hereditary and/or familial disease. 8. Social History Definition - ANSWER Includes marital status, occupation, educational attainment, hobbies, use of alcohol, tobacco, drugs, and lifestyles. 9. Review of Systems Abbreviation - ANSWER ROS 10. Review of Systems Definition - ANSWER This is an orderly and systematic check of each organ and system of the body by questions. Both positive and pertinent negative findings are documented. 11. 3 Body Processes Necessary for life are: - ANSWER Body Temperature, Respiration, Heart Function 12. 4 Vital Signs of Body Function are: - ANSWER Temperature, Pulse, Respiration, Blood Pressure 13. Define Body Temperature - ANSWER Is a balance between heart production and heart loss in conjunction with each other, maintained and regulated by the hypothalamus. 14. Thermometers - ANSWER Are used to measure temperature using the Fahrenheit and Centigrade or Celsius scale. 15. Temperature Sites - ANSWER Mouth, Rectum, Ear (Tympanic Membrane), and the axilla (underarm). 16. Normal Temperature Range for Rectal - ANSWER 98.6F to 100.6F 37.0C to 38.1C 17. Normal Temperature Range for Oral - ANSWER 97.6F to 99.6F 18. 36.5C to 37.5C 19. Normal Temperature Range for Axillary - ANSWER 96.6F to 98.6F 35.9C to 37.0C 20. Normal Temperature Range for Tympanic Membrane - ANSWER 98.6 F 37 C 21. Define Febrile - ANSWER Presence of Fever 22. Define Afebrile - ANSWER Absence of Fever 23. Define Fever - ANSWER Elevated body temperature beyond normal range. 24. Intermittent Fever - ANSWER Fluctuating fever that returns to or below baseline then rises again. 25. Remittent Fever - ANSWER Fluctuating fever that remains elevated; it does not return to baseline temperature. 26. Continuous Fever - ANSWER A fever that remains constant above the baseline; it does not fluctuate. 27. Define Defamation of Character - ANSWER This consists of injury to another person's reputation, name, or character through spoken (slander) or written (libel) words. 28. Define Negligence - ANSWER This is the failure to exercise the standard of care that a reasonable person would give under similar circumstances and someone suffers injury because of another's failure to live up to a required duty of care. The 4 Elements of Negligence: - ANSWER -Duty: duty of care -Derelict: breach of duty of care -Direct cause: legally recognizable injury occurs as a result of the breach of duty of care -Damage: wrongful activity must have caused the injury or harm that occurred Define Patient Confidentiality - ANSWER This is the key concept of HIPAA. All patients have a right to privacy and all information should remain privileged. Define Informed Consent - ANSWER This is consent given by the patient who is made aware of any procedure to be performed, its risks, expected outcomes, and alternative. Biological Hazards - Biological Safety Regulations - ANSWER -Disinfect the laboratory work area before and after each use when dealing with biologicals -Never draw a specimen through a pipette by mouth. This technique is not permitted in the laboratory -Always wear gloves -Sterilize specimens and any other contaminated materials and/or dispose of them through incineration -Wash hand thoroughly before and after every procedure Emergency First Aid - ANSWER The ability to recognize and react quickly to an emergency may be the difference of life or death for the patient. Define External Hemorrhage - ANSWER Controlling the bleeding is most effectively accomplished by elevating the affected part above heart level and applying direct pressure to the wound. Do not attempt to elevate a broken extremity as this could case further damage. Define Shock - ANSWER Occurs when there is insufficient return of blood flow to the heart, resulting in inadequate supply of oxygen to all organs and tissues of the body. Common Shock Symptoms: - ANSWER -Pale, Cold, Clammy Skin -Rapid, Weak Pulse -Increased, Shallow Breathing Rate -Expressionless Face/Staring Eyes First Aid For Shock - ANSWER -Maintain an open airway for the victim -Call for assistance -Keep the victim lying down with the head lower than the rest of the body -Attempt to control bleeding or cause of shock (if known) -Keep the victim warm until help arrives Define Cardiopulmonary Resuscitation - ANSWER Most healthcare institutions require their professionals to be certifies in CPR. It is important for all professional to maintain all certifications acquired. CPR stands for - ANSWER Cardiopulmonary Resuscitation Define Urinary Bacteria - ANSWER Enteric gram-negative bacteria that are always nitrite positive can convert urinary nitrate to nitrite. A positive nitrite test is an indication that a significant number of bacteria are present in the urine. Define Urinary Leukocytes - ANSWER The presence of increased numbers of leukocytes or white blood cells in the urine is an indicator of bacteriuria or urinary tract infection (UTI). Abbreviation for Urinary Tract Infection - ANSWER UTI Granulocytic leukocytes release: - ANSWER Esterase when the cells lyse. Testing for leukocyte esterase by: - ANSWER The reagent strip method is used in tandem with the microscopic examination of urine sediment for the diagnosis of bacteriuria or UTI. A positive test by the reagent strip method is indicated by a: - ANSWER Purple Color A _____-______ _____-______ urine sample is usually required for any bacterial culture. - ANSWER clean catch mid stream Probably the most common specialized urine test is the _____ _____. - ANSWER Pregnancy Test Abbreviation for Human Chorionic Gonadotropin - ANSWER hCG Abbreviation for Uterine Chorionic Gonadotropin - ANSWER UCG Increased levels of hCG are a natural marker for _____. - ANSWER Pregnancy Define Hemoccult Fecal Occult Test - ANSWER Is used to detect hidden blood in stool specimens. The 1st and last portion of the stool after the bowel movement usually contain concentrations of the substances most often required for testing. In order to conduct this test, a Hemmocult developing solution is applied to a stool specimen. Any trace of blue that appears within the specimen is a sign of a positive result. Define Throat Culture - ANSWER Are used to detect a bacterial, fungal, or ciral infection in the throat. In order to conduct this test, the patient should be placed in a comfortable lying or sitting position. After the patient have been asked to open their mouth, the MA should depress the patient's tongue then vigorously swab the throat with a sterile swab. After the specimen is collected, it should correctly labeled with the patient's information. Define Sputum Specimen - ANSWER Is used to determine the presence of pathogens in a patient's respiratory passage. When obtaining the specimen the MA should instruct the patient to cough deeply, using the abdominal muscles as well as the accessory muscles to bring up secretions from the lungs as well as the upper airways. After the specimen is collected, it should correctly labeled with the patient's information. Order of Draw for Capillary Specimens - ANSWER 1. Lavender Tube 2. Tubes with other additives 3. Tubes without additives PKU - ANSWER This test is ordered for infants to detect phenylketonuria, a genetic disease that causes mental retardation and brain damage. Test is done on blood from newborn's heel or on urine. Order of Draw (BeCause Better Specimens Generate Perfect Goals) - ANSWER 1. Blood Cultures 2. Light Blue Top Tubes 3. Serum or non-additive tube (Red or Red/Gray Top Tubes) 4. Green Top Tubes 5. Lavendar Top Tubes 6. Gray Top Tubes Define Infection Control/Chain of Infection - ANSWER Based on the fact that the transmission of infectious disease will be prevented or stopped when any level in the chain is broken or interrupted. Define Agents - ANSWER Are infectious , microorganisms that can be classified into groups namely: viruses, bacteria, fungi, and parasites. Define Portal of Exit - ANSWER The method by which an infectious agent leaves it reservoir. Define Standard Precautions and Transmission-Based Precautions - ANSWER Are controlled measures aimed at preventing the spread of the disease as infectious agents exit the reservoir. Define Mode Transmission - ANSWER Specific ways in which microorganism travel from the reservoir to the susceptible host. 5 Main Types of Mode Transmission: - ANSWER -Contact: direct and indirect -Droplet -Airborne -Common Vehicle -Vectorborne Define Portal Of Entry - ANSWER Allows the infectious agent access to the susceptible host. Common Entry Sites: - ANSWER -Broken Skin - Mucous Membranes -Body systems exposed to the external environment such as the respiratory, gastrointestinal, and reproductive. What methods are used to limit the transmission of infectious agents: - ANSWER -Wound Care -Transmission-Based Precautions -Aseptic Technique Define Susceptible Host - ANSWER The infectious agent enters a person who is not resistant or immune. Control at this level is directed towards the identification of the patients at risk, treat their underlying condition for susceptibility, or isolate them from the reservoir. Define Medical Asepsis - ANSWER The destruction of pathogenic microorganisms after them leave the body. It also involves environmental hygiene measures such as equipment cleaning and disinfection procedures. Define Disinfection - ANSWER This procedure used in medical asepsis using various chemicals that can be used to destroy many pathogenic microorganisms. Since chemicals can irritate skin and mucous membranes, they are only used on inanimate objects. Boiling water at what temperature is considered a form of disinfected: - ANSWER 212 F What is the ratio of bleach and water is a disinfected: - ANSWER 1:10 Define Surgical Asepsis - ANSWER All microbial life, pathogens, pathogens and non-pathogens, are destroyed before an invasive procedure is performed. Often used interchangeably. 4 Methods of Sterilization - ANSWER -Gas Sterilization -Dry Heat Sterilization -Chemical Sterilization -Steam Sterilization Define Gas Sterilization - ANSWER Often used for wheelchairs and hospital beds. Useful in hospitals, but costly for the office. Define Dry Heat Sterilization - ANSWER Requires higher temperature that steam sterilization but longer exposure times. Used for instruments that easily corrodes. Define Chemical Sterilization - ANSWER Uses the same chemical used for chemical disinfection, but the exposure time is longer. Define Steam Sterilization - ANSWER Uses steam under pressure to obtain high temperature of 250-254F with exposure times of 20-40 minutes depending on the item being sterilized. Define Hand Washing - ANSWER Is the most important means of preventing the spread of infections. A Routine Hand Washing Procedure: - ANSWER Uses plain soap to remove soil and transient bacteria. Hand Antisepsis requires: - ANSWER The use of antimicrobial soap to remove, kill or inhibit transient microorganisms. Symptoms/Signs of NRL Allergy IgE/histamine mediated - ANSWER Hives in area of contact with NRL. Cause of Irritant Contact Dermatitis - ANSWER Direct skin irritation by gloves, powder, soaps/detergents, incomplete hand drying. Cause of Allergic Contact Dermatitis - ANSWER Accelerators processing chemicals. Cause of NRL Allergy IgE/histamine mediated - ANSWER NRL proteins; direct contact with or breathing NRL proteins, including glove powder containing proteins, from powdered gloves or the environment. Prevention/Management for Irritant Contact Dermatitis - ANSWER Obtain medical diagnosis, avoid irritant product, consider use of cotton glove liners, consider alternative gloves/products. Prevention/Management for Allergic Contact Dermatitis - ANSWER Obtain medical diagnosis, identify chemical. Consider use of glove liners such as cotton. Use alternative glove material without chemical. Assure glove material is suitable for intended use (proper barrier). Prevention/Management for NRL Allergy IgE/histamine mediated - ANSWER Obtain medical diagnosis, allergy consultation, subsitute non-NRL, gloves for affected worker and other non-NRL products. Eliminate exposure to glove powder - use of reduce protein, powder free gloves for coworkers. Clean NRL-containing powder from environment. Consider NRL, safe enviroment. (Prescription) po - ANSWER From the Latin per os, or "by mouth" or "orally" (Prescription) pr - ANSWER From the Latin per rectum, or "by way of the rectum," by suppository (Prescription) sl - ANSWER sublingual (under the tongue) (Prescription) IV - ANSWER intravenous (Prescription) IM - ANSWER intramuscular (in the muscle) (Prescription) SQ - ANSWER short for subcutaneous (meaning under the skin) (Prescription) qd - ANSWER Every Day, from the Latin quaque die (Prescription) bid - ANSWER Twice a Day, from the Latin his in die (Prescription) tid - ANSWER Three Times a Day, from the Latin ter in die (Prescription) qid - ANSWER Four Times a Day, from the Latin quater in die (Prescription) pc - ANSWER After meals or not on an empty stomach, from the Latin post cibum (Prescription) qhs - ANSWER Each night, from the Latin quaque hora somni, or "at bedtime" (Prescription) prn - ANSWER As needed, from the Latin pro re nata, "as circumstances may require" The hear is: - ANSWER A hollow muscular organ located in the thoracic cavity between the lungs in a space called Mediastenum. The heart _____ is located at the level of the 2nd intercostal. - ANSWER Base The tip of the heart (_____) is located at the level of 5th intercostal and mid-clavicular line on the left. - ANSWER Apex Define Endocardium - ANSWER The innermost layer of the heart. It is a thin layer of epithelium very similar to vessels' endothelium, which covers the inside part of the heart. It forms the lining and folds back onto itself to form the heart valves and also covers the papillary muscles that anchor chordae tendinae, strings of connective tissue that keep in place the AV valves. The function of the Endocardium is: - ANSWER To prevent blood cell destruction and clotting. The Endocardium is: - ANSWER Also the layer in which the heart's conduction system is embedded. Define Myocardium - ANSWER The middle and contractile layer of the heart. The Myocardium is made up of: - ANSWER Special striated muscle fibers with strong connection with each other (intercalated disks) and branches that ensure a unified and simultaneous contraction of all muscle fibers. There is a high concentration of calcium ions in the space between the muscle fibers (interstitial space), which influences the force of the muscle contraction. Define "Heart Skeleton" - ANSWER Is made up of four rings of thick connective tissue. These rings which surround the base of the heart and large vessels, create the cardiac septum, and provide a solid connection between the heart chambers and a strong attachment for the heart valves. Define Pericardium - ANSWER The outermost layer of the heart. Attached with ligaments to the spinal column and diaphragm fixing the heart in its position. Built by two layers of connective tissue. The outer layer of the Pericardium is called: - ANSWER Parietal Pericardium The inner layer of the Pericardium is called: - ANSWER Visceral Pericardium or Epicardium The two layers of Pericardium are separated by: - ANSWER A thin layer of fluid to prevent friction. These layers and the fluid between them are referred to as the pericardial sac. A structure in the middle of the heart called the _____, divided the heart into two sides. - ANSWER Septum The right side of the heart pumps _____ blood with low pressure from the veins into the lungs (pulmonary circulation). - ANSWER Deoxygenated The left side of the heart pumps _____ blood with high pressure (blood pressure) toward the tissues through arteries (systemic circulations). - ANSWER Oxygenated The four chambers of the heart: - ANSWER -Right Atria -Left Atria -Right Ventricle -Left Ventricle Define Right Atrium - ANSWER Receives deoxygenated blood returning to the heart from the body via the superior vena cava which carries blood from the upper body and the inferior vena cava which carries blood from the lower body. Receives blood from the coronary sinus; the largest vein that drains the heart muscle's deoxygenated blood. Define Right Ventricle - ANSWER Receives deoxygenated blood from the right atrium which it pumps to the lungs for oxygenation through the pulmonary trunk and then to the pulmonary arteries. Define The Pulmonary Arteries - ANSWER Are the only arteries in the body that carry deoxygenated blood (because they are going away from the heart). Define the Left Atrium - ANSWER Receives oxygenated blood returning from the lungs via the right and left pulmonary veins. Define The Pulmonary Veins - ANSWER The only veins in the body that carry oxygenated blood (because they are going towards the heart). Define Left Ventricle - ANSWER Receives the oxygenated blood from the left atrium and pumps it to the body through the aorta, the largest artery of the body. The Heart Valves Purpose - ANSWER Is to prevent back flow of the blood thereby assuring uni-directional flow thru the heart. The Atrioventricular Valves (AV) are located: - ANSWER Between the atria and ventricles. AV Cusped Valves Characteristics are: - ANSWER -They have tough fibrous rings. -Long and strong leaflets (cuspids). -They have accessory organs, such as papillary muscles and chordea tendinae. Define Tricuspid Valve - ANSWER Is located between the right atrium and the right ventricle. As the name connotes, it has three cusps (or leaflets). Define Bicuspid Mitral Valve - ANSWER Is located between the left atrium and the left ventricle. It has two cusps (or leaflets) and it also called the mitral valve. Define Semilunar Valves - ANSWER They have half-moon shaped leaflets. Semilunar Valves Characteristics - ANSWER -Three Leaflets -Shallow in depth -They have no accessory organs Define Pulmonic Valve - ANSWER Located between the right ventricle and the pulmonary trunk. Define Aortic Valve - ANSWER Located between the left ventricle and aorta. Define Systole - ANSWER Is the period of contractions of both Arial and Ventricles. Define Diastole - ANSWER Is the period of relaxation and filling of all cardiac chambers. The right and left _____ _____ are the first branches coming out of Aorta and supply the heart with oxygenated blood. The blood runs through there arteries during diastole. Located on the epicardium. - ANSWER Coronary Arteries The left coronary artery has two branches: - ANSWER -Left Anterior Descending (LAD) -Left Circumflex (LCX) There is only one main artery that supplies the right side of the heart: - ANSWER Right Coronary Artery (RCA) Define Heart Sounds - ANSWER Are caused by the closure of the heart valves. S1 First Heart Sound (Lubb) - ANSWER Occurs during ventricle contraction and the closure of AV valves. S2 Second Heart Sound (Dupp) - ANSWER Occurs during ventricular relaxation when SL valves (Pulmonary and Aortic valves) close. Define Murmurs - ANSWER Are caused by diseases of the valves or other structural abnormalities. Define Heart Rate - ANSWER Is the number of heart contractions per minute. The normal heart rate is _____ to _____ bpm. - ANSWER 60 to 100 Abbreviation for Beats Per Minute - ANSWER bpm Abbreviation for Heart Rate - ANSWER HR Heart rate is controlled by _____ and _____ located in Aortic Arch and Carotid arteries. - ANSWER Chemo-receptors (chemical sensors) and Baro-Receptors (pressure receptors) The heart is under the influence by the autonomic nervous system (ANS) which is subdivided into the _____ and _____ nervous systems. - ANSWER Sympathetic and Parasympathetic Parasympathetic (Vagus Nerve) - ANSWER Generally has an inhibitory effect via the neurotransmitter. Acetylcholine may cause what to happen: - ANSWER -Slow SA pacemarker and HR -Slow the conduction of electricity in AV node -Decreased the strength of atrial and ventricular contraction Sympathetitc via the neurotransmitter Norepinehrine results: - ANSWER -Increases the HR -Increases the force of contraction -Increase the blood pressure -Via dopaminergic receptors increase the diameter of the visceral blood vessels and consequently visceral blood flow Define Heart as a Pump - ANSWER The blood volume ejected outside the heart is equal to the blood volume returning back 1 into the heart. Define Stroke Volume (Preload) - ANSWER Is the blood volume ejected outside the ventricle after each contraction. The Stroke Volume Depends on: - ANSWER -The volume of blood returning into the heart -The force of the myocardium contraction -Vascular resistance (After Load) Starling Law - ANSWER The greater the volume of blood inside the heart during diastole, the stronger the heart contraction force during the systole. Define Cardiac Ouput - ANSWER The amount of blood ejected outside the heart per minute. Cadiac Output Formula - ANSWER Stroke Volume x HR per/min Peripheral Vascular Resistance - ANSWER Is the force exerted against the blood flow and is determined by the diameter of the vessel. The lower the vascular resistance the less force is needed to eject the blood out of the heart during systole. Blood Pressure Formula - ANSWER Cardiac Output x Vascular Resistance EKG - ANSWER Graphical presentation of heart electricity (voltage) over time. This electricity is created by specialized cells called pacemaker cells. These cells generate electrical impulses spontaneously (without outside influence) and rhythmically (automatically). 4 Cardiac Cell Properties - ANSWER -Automaticity -Excitability -Conductivity -Contractility Define Automaticity - ANSWER The ability to spontaneously trigger electrical impulses without being stimulated by another source. Define Excitability - ANSWER (also called irritability) the ability to respond and react to a stimulus. Define Conductivity - ANSWER The ability to receive and transmit electrical impulses to adjacent cells. Define Contractility - ANSWER A myocardial cell's ability to shorten (or contract) in response to a stimulus. Define Depolarization - ANSWER Occurs when positively charged ions (such as sodium and calcium) rapidly move from outside the myocardial cell membrane to the inside, changing the overall charge from negative to a positive. Define Repolarization - ANSWER Occurs immediately after depolarization and is the movement of positively charged ions back to the outside of the cell, returning the cell back to its original polarized state. A cell must repolarize before it can depolarize again. Absolute Refractory Period - ANSWER Is the 1st phase of repolarization in which a myocardial cell is unable to react to any electrical stimulus. Relative Refractory Period - ANSWER Is the 2nd phase of repolarization during which time a strong enough electrical stimulus might cause new depolarization and contraction. Conduction System of The Heart - ANSWER Generates and delivers (conducts) the electricity to all the muscle fibers of the heart resulting in a smooth, complete contraction of the cardiac muscle fibers, which forcefully ejects the blood outside the heart. SA Node - ANSWER Found in the upper posterior portion of the right atrial wall just below the opening of the superior vena cava. It is the primary pacemaker of the heart and has a normal firing rate of 60-100 bpm. Define Internodal Pathways - ANSWER Consists of anterior, middle and posterior division that distribute electrical impulses generated by the SA node throughout the right and left atria to the atrio-ventricular (AV) node. Define AV Junction (AV node) - ANSWER This node is located at the posterior septal wall of the right atrium just above the tricuspid valve. There is normally a .12-.20 second delay of electrical activity at this level to allow blood to flow from the atria and fill the ventricles with blood. Bundle of His - ANSWER Found at the superior portion of the interventricular septum, it is the pathway that leads out of the AV node and connects to the Bundle Branches. Bundle Branches - ANSWER Located at the interventricular septum, the Bundle His divides into the right and left bundle branches, the function of which is to conduct the electrical impulse to the Purkinje fibers throughout the ventricles, Purkinje Fibers - ANSWER Found within the ventricular endocardium, it consists of a network of small conduction fibers that deliver the electrical impulses from the Bundle Branches to the ventricular myocardium. EKG is a _____ that measures the heart electricity traveling through the conductive system and an important tool for patient's diagnosis. - ANSWER Galvanometer EKG Evaluation: - ANSWER -Monitoring patient's HR -Evaluates injuries to the heart muscle -Evaluates the pacemakers and conductive system function -Evaluate the response toward medication -Provides a baseline record for medical procedure Define Electrode - ANSWER Is a paper, plastic or metal sensor placed on the patient's skin on a specific location and transmit it to the cable. Define Cable - ANSWER Is a wire that connects the electrode to the EKG machine (cardiac monitor). Define Lead - ANSWER Is a recorded tracing of the heart electricity from one or two electrodes that provides a specific view of the heart. Standard Bipolar Limb Leads - ANSWER Record electrical activity in the frontal plane. Electrodes are applied to the left arm (LA), the right arm (RA) and the left leg (LL). These leads record the difference in electricity between two electrode. Lead I - ANSWER The left arm is positive and the right arm is negative. (LA-RA) Lead II - ANSWER The left leg is positive and the right arm is negative. (LL-RA) Lead III - ANSWER The left leg is positive and the left are is negative. (LL-LA) Define Augmented Unipolar - ANSWER Also records electrical activity in the frontal plane. Define Augmented Unipolar Leads - ANSWER Record the heart electricity from one limb and compare it with a zero voltage lead in the center of the heart. AV stands for - ANSWER Augmented Coltage R stands for - ANSWER Right Arm (RA) L stands for - ANSWER Left Arm (LA) F stands for - ANSWER Left Leg (LL) Lead aVR - ANSWER The right arm is positive and the other limbs are negative. Lead aVL - ANSWER The left arm is positive and the other limbs are negative. Lead aVF - ANSWER The left leg (or foot) is positive and the other limbs are negative. Precordial Chest Unipolar Leads - ANSWER All these electrodes are positive and record the heart electricity in the horizontal plane. They include leads: V1, V2, V3, V4, V5, and V6. V1 - ANSWER Fourth intercostal space, right sternal border. V2 - ANSWER Fourth intercostal space, left sternal border. V3 - ANSWER Equidistant between V2 and V4. V4 - ANSWER Fifth intercostal space, left midclavicular line. V5 - ANSWER Fifth intercostal space, anterior axillary line. V6 - ANSWER Fifth intercostal space, midaxillary line. The Electrocardiographic Grid and Waves - ANSWER The EKG paper is a graph paper with horizontal and vertical lines at 1-mm intervals. A heavy line appears every 5mm. The horizontal axis represents time: - ANSWER 1mm = 0.04 seconds 5mm = 0.2 seconds The vertical axis represents: - ANSWER voltage, measures in millivolts (1/1000 part of a volt) but expressed in millimeters: 0.1mV-1mm. The tracing is marked on the paper by a stylus using _____. - ANSWER heat The running speed of an EKG machine is _____. - ANSWER 25mm/sec The EKG machine must be properly standardized so that 1mV will produce a deflection of _____. - ANSWER 10mm Define Waveform - ANSWER Refers to movement away from the isoelectric line either upward (positive) deflection or downward (negative) deflection. Define Segment - ANSWER Line between two waveforms. Define Interval - ANSWER Waveform plus a segment. Define Complex - ANSWER Several waveforms. Atrial Depolarization - ANSWER P wave P Wave - ANSWER Is the first deflection after the diastole, produced by atrial depolarization. It is smooth, round, not more than 2.5mm high and no more than 0.11 sec. Positive in I, II, and V2 to V6. Ventricular Depolarization - ANSWER QRS Complex, Q (q) Wave, R (r) Wave, S (s) Wave QRS Complex - ANSWER -Represents ventricular depolarization (activation) -The ventricle is depolarized from the endocardium to the myocardium, to the epicardium -Normal duration is no more than 0.1 sec (otherwise stated as "less than .12 sec) Q (q) Wave - ANSWER The initial negative deflection produced by ventricular depolarization. R (r) Wave - ANSWER The first positive deflection produced by ventricular depolarization. S (s) Wave - ANSWER The first negative deflection produced by the ventricular depolarization that follows the first positive deflection, (R) wave. Ventricular Repolarization - ANSWER T Wave and U Wave T Wave - ANSWER The first wave after the QRS complex has the following characteristics: -The deflection produced by ventricular repolarization -It is slightly asymmetric -No more than 5mm in height UWave - ANSWER Is the deflection seen following the T wave but preceding the diastole. -Represents repolarization of Purkinje fibers -Round and symmetric less than 1.5mm in height -A prominent U wave is due to hypokalemia (low potassium, blood level) PR Segment - ANSWER This segment is measured from the end of the P wave to the beginning of the QRS Complex. ST Segment - ANSWER This segment represents the time of ventricular contraction and the beginning of repolarization of both ventricles. It is measured from end of QRS to the beginning of the T wave. From J point to the onset of the T wave.This segment is compared to the PR segment to help identify myocardial ischemia or injury. PR Interval - ANSWER Is defined as P wave and PR segment and is measured from the beginning of P wave to the beginning of QRS complex. The normal interval is 0.12-0.2 sec. QT Interval - ANSWER It represents the total ventricular activity (ventricular depolarization PLUS ventricular repolarization), and it is measured from the beginning of QRS to the end of T wave. The normal duration of this interval depends on the age and the HR. RR Interval - ANSWER It is important to determine the HR and its regularity. This is the interval between two R waves. J (RST) Junction - ANSWER Point at which QRS complex ends and ST segment begins. Assesses the HR - ANSWER -6 second Method -Large Boxes Method -Small Boxes -Sequence Method Analyzing the EKG Strip - ANSWER -Assesses the HR -Assess Rhythm/Regularity -Identify and examine the P waves -Assess interval (PR, QRS,QT) -Evaluate ST segments and T waves -General Evaluation and Conclusion 6 second Method - ANSWER The number of QRS Complexes between 6 sec marks on the EKG paper is multiplied by 10. Used generally for estimating slow or irregular rhythms. Large Boxes Method - ANSWER Count the number of large boxes between two consecutive RR (one RR interval) and divide into 300 for the ventricular rate; and count large boxes between two consecutive P waves for the atrial rate. Used mainly in regular rhythms. Small Boxes - ANSWER One minute have 1500 small boxes (0.04 sec). Count the number of small boxes between an RR interval and divide into 1500. This method is more accurate and is used for regular rhythms only. Sequence Method - ANSWER Select the R that falls on a dark vertical line. Number the next consecutive dark line as 300, 150, 100, 75, 60, and 50. Note where the next R wave falls in relation to the dark lines. That is the heart rate. Assess Rhythm/Regularity - ANSWER The HR is considered regular is all the RR or PP intervals on the EKG leads are equal. If there are changes in their durations the rhythm is irregular. Identify and examine the P waves - ANSWER PP interval and measure the size of the P wave in different leads. Assess interval (PR, QRS,QT) - ANSWER Measure each of these intervals and determine if they are normal. Evaluate ST segments and T waves - ANSWER ST segment elevation or depression and/or T wave abnormalities can suggest the presence of myocardial ischemia or injury. General Evaluation and Conclusion - ANSWER Notify the doctor for any abnormality that you can find on the EKG strip. Arrhyythmias of Sinus Origin - ANSWER Where electrical flow follows the usual conduction pathway but is too fast, too slow, or irregular. Normal Sinus rate is - ANSWER 60-100 beats per minutes If the sinus rate goes beyond 100 per minute, it is called _____. - ANSWER Sinus Tachycardia If the sinus rate goes below 60 per minute, it is referred to as _____. - ANSWER Sinus Bradycardia Ectopic Rhythma - ANSWER Electrical impulses originate from somewhere else other than the sinus node. Conduction Blocks - ANSWER Electrical impulses go down the usual pathway but encounter blocks and delays. Pre-Excitation Syndromes - ANSWER The electrical impulses bypass the normal pathway and, instead, go down an accessory shortcut. Normal Sinus Rhythm - ANSWER The rhythm originated from the SA has the following characteristics: -HR 60-100 bpm -Similar P in all the leads in front of all QRS (0.1 sec) -A constant PR (0.12 to 0.2) sec interval in all the leads, regular rhythm Sinus Bradycardia - ANSWER -HR less than 60 bpm -Normal equal P and QRS in all the leads, as well as normal PR intervals -Diastolic pause is longer (main graphic characteristic) -Bradycardia decreases the blood flow in the brain and other body tissues Sinus Tachycardia - ANSWER -HR over 100 bpm -Normal equal P and QRS in all the leads, as well as normal PR intervals -Diastolic pause is very small or nonexistent (main graphic Characteristic) -Tachycardia reduces the blood supply to the cardiac muscle Sinus Arrhythmia - ANSWER -HR 60 to 100 bpm -Normal equal P and QRS in all leads, as well as normal PR intervals -Different diastolic pause after each systole. If there are changes with the respiration is names. Normal Sinus Rhythm (Picture) - ANSWER Sinus Bradycardia (Picture) - ANSWER Sinus Tachycardia (Picture) - ANSWER Sinus Arrhythmia (Picture) - ANSWER Supraventricular Tachycardias (Picture) - ANSWER Atrial Tachycardia (AT) - ANSWER It is cause by an irritable focus in the atria that fires electrical impulses after the normal firing of the SA node pacemaker. HR is regular between 100 and 150 bpm. AV Reentry Tachycardia - ANSWER Is caused when the electrical impulse passes through a passage other than AV node. Cardiac rhythm is regular but up to 250 bpm. It is an emergency. Notify the Doctor. Atrial Flutter (Picture) - ANSWER Atrial Flutter - ANSWER Is characterized by rapid depolarization of a single atrial focus at a rate of 250-350 bpm. -b/c the AV node cannot transmit every impulse at excessive rates, there is typically a slower ventricular rate (often appearing at a 2:1, 3:1, 4:1, etc, conduction ratio). It is an emergency. Notify the Doctor. Atrial Fibrillation (Picture) - ANSWER Atrial Fibrillation - ANSWER Is caused by multiple irritable sites all over the atria firing at a rate exceeding 350 bpm. These rapid impulses case quivering (fibrillation) of the muscular fibers, which results in a drastic decrease in the cardiac output, blood stagnation and the formation of a clot. It is an emergency. Notify the Doctor. Premature Ventricular Complex (PVC) (Picture) - ANSWER Premature Ventricular Complex (PVC) - ANSWER A premature ventricular complex arises from an irritable site within the ventricles. -The ORS is typically greater than 0.12 sec because the ventricular depolarization is abnormal or aberrant -T wave are usually in opposite direction of the QRS complex -A full compensatory pause usually follows Ventricular Tachycardia (VT) (Picture) - ANSWER Ventricular Tachycardia (VT) - ANSWER Is characterized by 3 or more PVC's in a row at rate over 100 bpm. -Regular fast rhythm, 100 to 250 bpm - No P waves -Wide, bizarre QRS complexes with T waves pointing in opposite direction from main QRS direction Ventricular Fibrillation (VF) (Picture) - ANSWER Ventricular Fibrillation (VF) - ANSWER It is produced by multiple electrical sites firing electrial impulses at the same time resulting in quivering of the ventricles myocardial muscle fibers, but not a uniform contraction. It is an emergency. Notify the Doctor. Asystole (Picture) - ANSWER Asystole (cardiac Arrest, Standstill) - ANSWER It is a total absence of ventricular electrical activity. It is an emergency. Notify the Doctor. Atrio-Ventricular Blocks (AV Blocks) - ANSWER Defined as a delay or interruption of the electric impulse conduction beyond the AV node. It is evaluated by measuring the PR interval in EKG traces. The PR interval is the key of differentiation and classification of the AV blocks. Type 1 First Degree AV Block (Picture) - ANSWER Type 1 First Degree AV Block - ANSWER It is characterized by a delay of impulses at the level of AV Node. Type II Second Degree AV Block (Picture) - ANSWER Type II Second Degree AV Block - ANSWER Some of the atrial impulses, but not all, are blocked at the AV node level. Because SA node fires regular rhythmic impulses, each P wave occurs in a regular interval across the EKG strip, but no all P waves will be followed by a QRS complex. Type II Second Degree AV Block (Mobitz) (Picture) - ANSWER Type II Second Degree AV Block (Mobitz) - ANSWER It is a more serious pathology. Conducted P waves have a constant PR interval; but there are always non-conducted P waves between cardiac cycles, usually producing a "conduction ratio" between atria and ventricles. Third Degree AV Block - ANSWER This type of AV block is also called a Complete Heart Block, or CHB, because impulses generated by the SA node are completely blocked before reaching the ventricular muscle fibers. The atria and ventricles beat independently from each other. Third Degree Block's Characteristics - ANSWER -Atrial rate is greater than ventricular rate -P waves are normal, there are no measurable PR intervals -The atrial rhythm (P waves) is regular;AND the ventricular rhythm is regular (QRS complexes) -There is no relationship between P waves and QRS complexes -If the escape rhythm is ventricular, the QRS complexes will be abnormally wide with a slower ventricular rate Define Ischemia - ANSWER Insufficient blood supply to the myocardium. Atherosclerosis of the coronary arteries is the most common cause of the blood supply reduction. Define Myocardial Infarction MI - ANSWER Sudden death of the myocardial tissue due to an abrupt cessation of the blood flow. Clotting and total obstruction of a coronary artery are frequently superimposed on an already narrowed vessel from atherosclerosis. _____ ischemic injury is manifested by ST segment depression in the leads recording in front of the ischemic site. - ANSWER Subendocardial _____ and _____ injury is manifested by ST segment elevation in the leads recording in front of the lesion. - ANSWER Subepicardial and Transmural Myocardial Infarction Characteristics - ANSWER -Marked ST elevation with hyperacute T waves reflect complete muscular wall damage -In later stages (sub-acute MI) deep Q waves are seen on the leads facing the lesion manifesting necrosis -Pathological Q waves and inverted T waves are signs of fibrosis and scar tissue formation It is an Emergency. Notify The Doctor. Whats does WHO stand for? - ANSWER World Health Organization The World Health Organization criteria for the diagnosis of myocardial infarction are the presence of at least two of: - ANSWER -Clinical history of ischemic-type of chest discomfort -Changes on serial EKG tracings -Rise and fall in serum cardiac markers demonstrating cardiac tissue damage Define Artifact - ANSWER An unwanted interference or jitter on the EKG recording. This makes the EKG reading difficult or impossible, as well as can lead to a misdiagnosis. Define Somatic Tremor - ANSWER It is a jittery pattern caused by the patient's shivering or by shaking wires. Help the patient relax, cover the patient, make sure that the wires are correctly placed, or try the examination two more times. Redo the EKG until the tracing is more readable. Define Wandering Baseline - ANSWER Is it when the baseline moves up and down on the EKG paper. It is often caused by lotion or sweat on the skin interfering with the signal transmitted to the machine. Cleaning the site of the electrode and properly placing it resolves the interference. 60-cycle Interference - ANSWER Cause by improperly grounded electrical equipment that is directly or indirectly in contact with the patient. Cellular phones and pagers may also interfere with the EKG trace. Disconnect and remove all the electric objects from the patient or near by the machine. Broken Recording - ANSWER Can be caused by a damaged wire or loose electrodes. If the probes are placed properly, the cause is origination from a broken or damaged wire. Use a different EKG machine or replace the wires. Never use a damaged or malfunctioning machine. Stress Testing - ANSWER Is a noninvasive diagnostic procedure indirectly, the presence and severity of coronary artery disease and the heart muscle lack of blood supply. Stress test is performed through _____ or _____ while hooked up to an EKG monitor. The limb leads are applied to the torso of the patient rather than on the extremities. - ANSWER Exercise (by having the patient walk on a treadmill or by pedaling on a bicycle) Pharmacologically (by administration of medication that causes increase in heart rate) Exercise Stress Test - ANSWER This test is performed until at least 85% of the target heart rate is reached or symptoms or EKG changes develop which requires the test to be terminated. Target heart rate is 220 minus patient's age. Pharmacologic Stress Test - ANSWER This test is appropriate for patients with physical limitation. Medications such as adenosine, dipyridamole, or dobutamine are given intravenously through an IV line to cause the heart rate to climb to the target level or the same symptoms and EKG changes as the exercise test develop. The test is concluded after 85% of the target heart rate is achieved. Ambulatory EKG Monitoring - ANSWER Is mainly, but not only, used for diagnosis of cardiac dysrhythmias (disorders of the heart rhythm). It can also evaluate the heart rate, rhythm and function during daily activities. Holter Monitor - ANSWER This is an ambulatory EKG done to rule out intermittent arrhythmia or ischemia that could be missed on a a routine EKG. 5 electrode are attached to the patient's trunk instead on the arms and leg to prevent muscle artifact. Typical Electrode Placement for Holter monitoring: - ANSWER -2 exploring electrodes are placed over bone (to minimize motion artifact) near the V1 (over the 4th or 5th rib to the right of the sternum) and V5 (over the 5th rib at the left midaxillary line) -2 indifferent electrodes placed over the sternal head -One ground electrode placed over the 9th or 10th rib at the right midaxillary line Recording artifacts can result from the following: -With an analog system - ANSWER Incomplete tape erasure - this can result in EKG tracings belonging to two different patients confounding both the scanner and the interpreter. Tape drag within the apparatus - this will result in recording of spuriously rapid cardiac rhythms. A narrowing of all EKG complexes and intervals should give clue to this situation. Recording artifacts can result from the following: -Battery Depletion - ANSWER This may result in varying QRS amplitude Recording artifacts can result from the following: -Loose Connection - ANSWER Intermittently loose connection in the insertion of the electrodes into the recording apparatus can result in the absence of all EKG signals which may mimic bradycardia-tachycardia syndrome. Clue to this artifact is the attenuated QRST morphology of the complexes beginning and ending the pause in rhythm. Recording artifacts can result from the following: -Movement of Electrode - ANSWER This may occur during scratching the chest near the electrodes and can produce tracings that look like malignant ventricular arrhythmias. However, the underlying rhythm and rate remain undisturbed and should give clue to this artifact. Common Cardiovascular Agents -Oxygen - ANSWER Given to all patients with angina (acute severe chest pain). Causes vasodilation and protests the tissues from hypoxia. It can be administered through a cannula or a facial mask. Define Angina - ANSWER Acute severe chest pain Common Cardiovascular Agents -Epinephrine - ANSWER A sympathetic drug used to manage cardiac arrest, because increases heart contractibility. Common Cardiovascular Agents -Isoproterenol (Isuprel) - ANSWER Produces an overall increase in heart rate and myocardial contractility, but newer agents have replaced it in most clinical settings. Common Cardiovascular Agents -Dopamine (Intropin) - ANSWER This drug is indicated and is used in cases with hypotension. It causes vasoconstriction. It should be used at the lowest dose that produces adequate perfusion of vital organs. Define Hypotension - ANSWER Systolic blood pressure is less than 90 mmHG Define Vasoconstriction - ANSWER Narrowing of the blood vessel. Common Cardiovascular Agents -Beta Blockers (Propranolol, Metoprolol, Atenolol, and Esmolol) - ANSWER Reduce heart rate, blood pressure, myocardial contractility, and myocardial oxygen consumption which make then effective in the treatment of angina pectoria and hypertension. Beta Blockers - ANSWER Propranolol, Metoprolol, Atenolol, and Esmolol Common Cardiovascular Agents -Lidocaine - ANSWER Is the drug of choice for the suppression of ventricular ectopy (a beat located outside the conductive system) contractions (PVC), including ventricular tachycardia and ventricular flutter. Verapamil - ANSWER Is used in the treatment of paroxysmal supraventricular tachycardia (PSVT), effective in terminating more than 90% of episodes of PVST in adults and infants. Digitals - ANSWER Increases the force of cardiac contraction as well as cardiac output. This is a drug with high toxicity, therefore patients require constant monitoring for signs and symptoms of toxicity such as: yellow vision, nausea, vomiting, and drowsiness. Morphine Sulfate - ANSWER Is the traditional drug of choice for the pain and anxiety associated with acute myocardial infarction. In high doses, may cause respiratory depression. This is a controlled substance. Nitroglycerin - ANSWER Is a powerful smooth muscle relaxant effective in relieving angina pectoris. Headache is a common side effect. Hypotension may occur and patients should be instructed to sit or lie down while taking this medication. The Circulatory System - ANSWER The function of this system is to deliver oxygen, nutrients, hormones, and enzymes to the cells (exchange is done at the capillary level) and to transport cellular waste sure as carbon dioxide and urea to the organs (lungs and kidneys, respectively) where they can be expelled from the body. The average adult has _____ to _____ liters of blood. - ANSWER 5 to 6 The blood vessels are: - ANSWER Aorta, Arteries, Arterioles, Capillaries, Venule, Veins, Superior and Inferior Vena Cavae. The blood vessels, except for the _____, are composed of 3 layers. - ANSWER Capillaries Blood Vessels Layers: The outer connective tissue layer is called the _____ _____. - ANSWER Tunica Adventitia Blood Vessels Layers: The middle smooth muscle layer is called the _____ _____. - ANSWER Tunica Media Blood Vessels Layers: The inner endothelial layer is called the _____ _____. - ANSWER Tunica Intima The aorta, arteries, and arterioles carry _____ blood from the heart to the various parts of the body. - ANSWER Oxygenated The venules, veins and the superior and inferior vena cavae carry _____ blood back to the heart. - ANSWER Deoxygenated The capillaries, composed of a layer of _____ _____, connect the arterioles and venules - ANSWER Endothelial Cells The liquid portion of blood is called ______. - ANSWER Plasma The cellular portion of blood is called the _____ _____. - ANSWER Formed Elements Plasma comprises _____ of the circulating blood and it contains proteins, amino acids, gasses, electrolytes, sugars, hormones, minerals, vitamins, and water (92%). - ANSWER 55% The formed elements constitute the remaining _____ of the blood. They are erythrocytes (red blood cells), which comprise 99% of the formed elements, the leukocytes (white blood cells) and the thrombocytes (platelets). - ANSWER 45% All blood cells normally originate from the stem cells in the _____ _____. - ANSWER Bone Marrow Erythrocytes contain: - ANSWER -Hemoglobin, the oxygen-carrying protein The leukocytes function is to provide the body protection against _____. - ANSWER Infection The normal amount of WBC's (white blood cells) for an adult is _____ to ______ per microliter. - ANSWER 5,000 to 10,000 The 5 types of WBC's: - ANSWER -Neutrophils -Lymphocytes -Monocytes -Eosinophils -Basophils Neutrophils - ANSWER The most numerous, comprise about 40% to 60% of WBC population. The are phagocytic cells, meaning, they engulf and digest bacteria. Their # increases in bacterial infection, and often, the first one on the scene. Lymphocytes - ANSWER The 2nd most numerous, comprising about 20% to 40% of the WBC population. Their number increases in viral infection, and they play a role in immunity. Monocytes - ANSWER Comprising 3% to 8% of the population, they are also the largest WBC's. Their number increases in intracellar infections and tuberculosis. Eosinophils - ANSWER Represent 1% to 3 % of the WBC population. They are active against antibody-labeled foreign molecules. Their numbers are increased in allergies, skin infections, and parasitic infections. Basophils - ANSWER Account for 0% to 1 % of WBC's in the blood. They carry histamine, which released in allergic reactions. Hemostatis - ANSWER Is the process by which blood vessels are repaired after injury. Hemostatis Stage 1: Vascular phase - ANSWER Injury to a blood vessel causes it to constrict slowing the flow of blood. Hemostatis Stage 2: Platelet phase - ANSWER Injury to the endothelial lining causes platelets to adhere to it. Hemostatis Stage 3: Coagulation phase - ANSWER This involves a cascade of interactions of coagulation factors that converts the temporary platelet plug to stable fibrin clot. Hemostatis Stage 4: Fibrinolysis - ANSWER This is the breakdown and removal of the clot. The preferred site for venipuncture is the _____ _____ of the upper extremities. - ANSWER Antecubital Fossa Median Cubital Vein - ANSWER The vein of choice because it is large and does not tend to move when the needle is inserted. Cephalic Vein - ANSWER The 2nd choice. It is usually more difficult to locate and has a tendency to move, however, it is often the only vein that can be palpated in the obese patient. Basilic Vein - ANSWER The 3rd choice. It is the least firmly anchored and located near the brachial artery. If the needle is inserted too deep, this artery may be punctured. Sclerosed Veins - ANSWER These veins feel hard or cordlike. Can be caused by disease, inflammation, chemotherapy or repeated venipunctures. Thrombotic Veins - ANSWER Unsuitable Veins Tortuous Veins - ANSWER These are winding or crooked veins. There veins are susceptible to infections, and since blood flow is impaired, the specimen collected may produce erroneous test results. Do not draw blood from an arm with _____ _____ running into it. - ANSWER IV Fluids Supplies for a Venipuncture: - ANSWER -Laboratory Requisition slip and pen -Antiseptic -Vacutainer Tubes -Vacutainer Needles -Needle Adapters -Winged Infusion Sets -Sterile Syringes and Needles -Tourniquets -Chux -Specimen Labels -Gloves -Needle Disposal Container Antiseptic - ANSWER -Prepackaged 70% isopropyl alcohol pads are the most commonly used -For collections that require more stringent infection control such as blood cultures and arterial punctures Povidone-iodine solution is commonly used -For patients allergic to iodine, chlorhexidine gluconate is used. Vacutainer Tubes - ANSWER Color-coded for specific tests and available in adult and pediatric sizes. Vacutainer Needles - ANSWER -These are disposable and are used only once both for single-tube draw and multidraw (more than one tube) -Needle sizes differ both in length and gauge. 1-inch and 1.5 inch long are routinely used Needle Adapters - ANSWER Also called the tube holder. One end has a small opening that connects the needle, and the other end has a wide opening to hold the collection tube. Winged Infusion Sets - ANSWER -Used for venipuncture on small veins such as those in the hand. They are also used for venipuncture in the eldery and pediatric patients. -The most common size is 23 gauge, 1/2 to 3/4 inch long. Sterile Syringes and Needles - ANSWER 10-20ml syringe is used when the Vacutainer method cannot be used. Tourniquets - ANSWER -Prevents the venous outflow of blood from the arm causing the veins to bulge thereby making it easier to locate the veins. -The most common is a latex strip -Blood pressure cuffs may also be used Chux - ANSWER An impermeable pad used to protect the patient's clothing and bedding. Specimen Labels - ANSWER To be placed on each tube collected after venipuncture. Gloves - ANSWER Must be always be worn when collecting blood specimen. Needle Disposal Container - ANSWER Must be clearly marked puncture-resistant biohazard disposal containers. NEVER RECAP! The medical assistant uses 3 skills when contacting patients for phlebotomy: - ANSWER -Social -Clerical -Technical Blood Request forms should include the following: - ANSWER -Patient's name and age from ID plate or wristband -Identification # -Date and time the specimen is obtained -Name or initials of person who obtains the specimen -Accessioning # -Physician's name -Department for which work is being done -Other useful info. Fasting - ANSWER Some test such as those for glucose, cholesterol, and triglycerides require that the patient abstain from eating for at least 12 hours. Edema - ANSWER Is the accumulation of fluid in the tissues. Collection from edematous tissue alters test results. Fistula - ANSWER Is the permanent surgical connection between an artery and a vein. Are used for dialysis procedures and must never be used for venipuncture's due to the possibility of infection. Common causes of Failure to Obtain Blood: - ANSWER -The tube has lost its vacuum -Improperly positioned needle. -Collapsed Vein Hematoma - ANSWER The most common complication of phlebotomy procedure. Hemoconcentration - ANSWER The increase in proportion of formed elements to plasma caused by the tourniquet being left too long. Phlebitis - ANSWER Inflammation of a vein as a result of repeated venipuncture on that vein. Petechiae - ANSWER These are tiny non-raised red spots that appear on the skin from rupturing of the capillaries due to the tourniquet being left on too long or too tight. Thrombus - ANSWER This is a blood clot usually a consequence of insufficient pressure applied after the withdrawal of the needle. Thrombophlebitis - ANSWER Inflammation of a vein with formation of a clot. Septicemia - ANSWER This is a systemic infection associated with the presence of pathogenic organism introduced during a venipuncture. Trauma - ANSWER This is an injury to underlying tissues caused by probing of the needle. Two-Hour Postprandial Test - ANSWER This is used to evaluate diabetes mellitus. Fasting glucose level is compared with the level 2 hours after eating a full meal or ingesting a measured amount of glucose. Oral Glucose Tolerance Test (OGTT) - ANSWER This test is used to diagnose diabetes mellitus and evaluate patients with frequent low blood sugar. Fasting Specimens - ANSWER This requires collection of blood while the patient is in the basal state, that is, the patient has fasted and refrained for strenuous exercise for 12 hours prior to the drawing. Time Specimens - ANSWER -To determine blood levels of medications -To monitor changes in a patients conditions -to measure blood levels of substances exhibiting diurnal variation Therapeutic Drug Monitoring - ANSWER This test is used to monitor the blood levels of certain medication to ensure patient safety and also maintain a plasma level. Blood Cultures (BC) - ANSWER They are ordered to detect presence of microorganisms in the patient's blood. Usually ordered STAT or as a timed specimen. Cold Agglutinins - ANSWER Are antibodies produced in response to Mycoplasma pneumoniae infection (atypical pneumonia). The antibodies formed may attach to red blood cells at temperatures below body temperature, and as such, the specimen must be kept warm until the serum is separated from the cells. Chilled Specimens - ANSWER Some tests require that the specimen collected by chilled immediately after collection in crushed ice or ice and water mixture. Some of the tests that require chilled specimen are: - ANSWER -Arterial Blood Gases -Ammonia -Lactic Acid -Pyruvate -ACTH -Gastrin -Parathyroid Hormone Light-Sensitive Specimens - ANSWER Specimens are protected from light by wrapping the tubes in aluminum foil immediately after they are drawn. Exposure to light could alter the test results for: - ANSWER -Bilirubin -Beta-carotene -Vitamins A & B6 -Porphyrins Dermal Punctures (Microcapillary Collection) - ANSWER May be done on both pediatric and adult patients. Dermal Punctures (Infants) - ANSWER The heel is used. Areas recommended are the medical and lateral areas of the plantar surface of the foot. Precautions when performing a dermal puncture: - ANSWER -Do not puncture deeper than 2.0mm -Do not perform dermal punctures on previous puncture sites -Do not use the back of the heel or arch of the foot -Use the medial and lateral areas of the plantar surface of the heel Dermal Punctures (Older children and adults) - ANSWER The distal segment of the 3rd or 4th finger of the non-dominant hand is recommended site. Lavender Top Tube - ANSWER Contains the anticoagulant ethylenediaminetetraacetic acid (EDTA). EDTA inhibits coagulation by binding to calcium present in the specimen. The tubes must be filled at least two-third full and inverted eight times. Lavender Top Tube Common Test: - ANSWER CBC (Complete Blood Count) Included: RBC count, WBC count and Platelet count; WBC differential count; Hemoglobin and Hematocrit determinations; ESR (Erythrocyte Sedimentation Rate); Sickle Cell Screening. Light-Blue Top Tube - ANSWER Contains the anticoagulant Sodium Citrate, which also prevents coagulation by binding to calcium in the specimen. The tube must be filled completely to maintain the ratio of nine parts blood to one part sodium citrate, and should be inverted 3 to 4 times. Light-Blue Top Tube Common Test - ANSWER Coagulation Studies-Prothrombin Time (PT)-evaluates the extrinsic; system of the coagulation cascade and monitors; Coumadin therapy; Activated Partial Thromboplastin Time (APTT, PTT) - Evaluates the intrinsic system of the coagulation cascade and monitors Heparin therapy. Fibrinogen Degradation Products (FDP) Thrombin Time (TT); Factor assays, Bleeding Time (BT) Green Top Tube - ANSWER Contains the anticoagulant Heparin combined with sodium, lithium, or ammonium ion. Heparin works by inhibiting thrombin in the coagulation cascade. It is not used for hematology because heparin interferes with the Wright's stained blood smear. This tube should be inverted eight times. Green Top Tube Common Test - ANSWER Chemistry test: performed on plasma such as Ammonia, carboxyhemoglobin & STAT electrolytes. Gray Top Tube - ANSWER Contains additives and anticoagulants. Contains glucose preservative (antiglycolytic agent): sodium fluoride - preserves glucose for 3 days; or lithium iodoacetate-preserves glucose for 24 hours. Gray Top Tube Common Test - ANSWER Fasting blood sugar (FBS); Glucose tolerance test (GTT); Blood alcohol levels; Lactic acid measurement. Red/Gray (Speckled) Top Tube - ANSWER Contain clot activators: glass particles, silica and celite which hastens clot formation, and thixotropic gel, a serum separator which when centrifuged forms a barrier between the serum and the cells preventing contamination of the serum with cellular elements. Red/Gray (Speckled) Top Tube Common Test - ANSWER Most Chemistry Test Red Top Tube - ANSWER Contains no additive or anticoagulant. Collected blood clots by normal coagulation process in 30-60 minutes. This is no need to invert the tube after collection. Red Top Tube Common Test - ANSWER Serum chemistry test: Serology test; blood bank (glass only) Yellow Top Tube (sterile) - ANSWER Contains the anticoagulant sodium polyanetholesulfonate (SPS). These are used to collect specimens to be cultured for the presence of microorganisms. Define Quality Control (QC) - ANSWER Purpose of a quality control program is to provide reliable data about the patient's health status by ensuring the accuracy of test results while detecting and elimination errors. Electrophoresis - ANSWER Analyzes chemical components of blood such as hemoglobin and serum, urine and cerebrospinal fluid, based on the differences in electrical charge. Toxicology - ANSWER Analyzes plasma levels of drugs and poisons. Immunochemistry - ANSWER This section uses techniques such as radio immunoassay and enzyme immunoassay to detect and mausure substances such as hormones, enzymes and drugs. Bacteriology - ANSWER The study of bacteria. Parasitology - ANSWER The study of parasites. Mycology - ANSWER The study of fungi. Virology - ANSWER The study of viruses. ABO Blood Group System (4) - ANSWER -Group A blood has "A" antigen -Group B has a "B" antigen -Group AB has both "A" and "B" antigens -Group O has neither "A" nor "B" antigen on the cell membrane Rh Blood Group System - ANSWER The presence or absence of the "D" antigen on the RBC membrane determines whether a person is RH positive of negative. Microscope - ANSWER One of the most commonly used instruments in the medical laboratory. Low Power Objective (16mm, 10X) - ANSWER This allows the item being viewed to be magnified ten times larger than life. High Power Objective (4-mm, 40X) - ANSWER By combining the ten-power (10X) ocular lens with the magnification power of forty times life (40X), the magnification vision is increased to four hundred times the normal size. Oil Immersion Objective (1.8mm, 100X) - ANSWER This objective enables us to reach a possible total magnification of one thousand times normal life size by multiplying the ocular lens magnification (10X) by one hundred (100X), (10X x 100X = 1000X). Meter - ANSW