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Chief complaint (CC): the reason \vhy the patient came to see the physician
History of present illness (HPI): this is an explanation of the chief complaint to determine the onset of the illness; associated symptoms; what the patient has done to treat the condition, etc.
Past, Family and Social History PFSH
Past medical history includes all health problems, major illnesses, surgeries the patient has had, current medications complete with reasons for taking them, and allergies.
Family history summary of health problems of siblings, parents, and other blood relatives that could alert the physician to hereditary and/or familial diseases.
Social history includes marital status, occupation, educational attainment, hobbies, use of alcohol, tobacco, drugs, and lifestyles.
Review of Systems 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
Vital Signs Reflect the functions of three body processes necessary for life: o Body temperature o Respiration o Heart function
The four vital signs of body function are Temperature o Pulse o Respiration o Blood pressure
Temperature Body temperature is a balance between heat production and heat loss in conjunction with each other, maintained and regulated by the hypothalamus.
Rectal Oral Axillary Tympanic Rectal 98.6Fto 100.6F ( 37.0C to 38.1 C)Oral 97.6F to 99.6F (36.5C to 37.5C)Axillary 96.6F to 98.6F (35.9C to 7.0C) Tympanic Membrane 98.6F (37C)
Some terms used to describe body temperature are: Febrile - presence of fever Afebrile - absence of fever
Fever - elevated body temperature beyond normal range. Types of fever are • Intermittent: fluctuating fever that returns to or below baseline then rises again. • Remittent: fluctuating fever that remains elevated; it does not return to baseline temperature. • Continuous: a fever that remains constant above the baseline; it
Oral temperature is the most common method of measurement; however, it is not taken from the following patients: -infants and children less than six years old -patients who has had surgery or facial, neck, nose, or mouth injury those receiving oxygen -those with nasogastric tubes -patients with convulsive seizure -hemiplegic patients -patients with altered
Oral temperature Wait for 30 minutes to take the oral temperature in patients who have just finished eating, drinking, or smoking. When taking the temperature, leave the thermometer in the patient's mouth for 3-5 minutes or as required by agency policy.
Rectal temperature is taken when oral temperature is not feasible. However, it is not taken from the following patients: -patients with heart disease -patients with rectal disease or disorder or has had rectal surgery patients with diarrhea
Rectal temperature It is taken with the patient in a side-lying position and the thermometer and the patient's hip is held throughout the procedure so the thermometer is not lost in the rectum or broken.
Axillary temperature is the least accurate and is taken only when no other temperature site can be used. The axilla, (the underarm) should be clean and dry and the thermometer should be held in place for 5-10 minutes or as required by the facility policy.
Tympanic temperature is useful for children and confused patients because of the speed of operation of the tympanic thermometer. A covered probe is gently inserted into the ear canal and temperature is measured within seconds (1-3 seconds). It is not used if the patient has a
apical pulse is a more accurate measurement of the heart rate and it is taken over the apex of the heart by auscultation using the stethoscope. It is used for patients with irregular heart rate and for infants and small children.
Respiration Apnea - this is a temporary complete absence of breathing which may be a result of a reduction in the stimuli to the respiratory centers of the brain. Tachypnea - this is a respiration rate of greater than 40/min. It is transient in the newborn and mayb
Respiratory rhythm refers to the pattern Cheyne-Stokes - this is a regular pattern of irregular breathing rate. Orthopnea - this is difficulty or inability to breath unless in an upright position.
Depth of respiration refers to the amount of air that is inspired and expired Hvpoventilation: state in which reduced amount of air enters the lungs resulting in decreased oxygen level and increased carbon dioxide level in blood. It can be due to breathing that is too shallow, or too slow, or to diminished lung function Hyperpnea
Blood Pressure The size of the cuff of the sphygmomanometer will depend on the circumference of the limb and not the age of the patient The width of the inflatable bag within the cuff should be about 40° ° of this circumference - 12 cm to 14 cm in an average adult. The length of the bag should be about 80% of this circumference - almost long enough to encircle the arm. Cuffs that are too
Anthropometric Measurements comparative measurements of the body Length, height, weight, weight-far-length, and head circumference Height, weight, body mass index (EMf), waist-to-hip ratio, and percentage of body fm are the measurements used for adults.
Physical Examination Inspection observation to detect significant physical features or objective dataPalpation: The examiner uses the sense of touch Percussion - This involves tapping or striking the bodyAuscultation Listening to the sounds prouduced by internal organs
Inspection General appearance State of nutrition Body habitus Symmetry Posture and gait Speech
MA role in the PE room preparation patient preparation assisting physician
Horizontal Recumbent Position is used for most physical examinations. The patient lies on his/her back with legs extended. Arms may be above the head, alongside the body or folded on the chest.
Dorsal Recumbent Position is when the patient is on his/her back with knees flexed and soles of the feet flat on the bed.
Fowler's Position is used to promote drainage or to ease breathing. A sitting or semi-sitting position where the back of the examination table is elevated to either 45 degrees
Dorsal Lithotomy Position is used for examination of pelvic organs. This position is similar to the dorsal recumbent position, except that the patient's legs are well separated and thighs are acutely flexed. The feet are usually placed in stirrups
Prone Position is used to examine the spine and back. The patient lies on his/her abdomen with head turned to one side for comfort, the arms may be above head or alongside the body.
Sim's Position is used for rectal examination. The patient is on his/her left side with the right knee flexed against the abdomen and the left knee slightly flexed. The left arm is behind the body; the right arm is placed comfortably.
Knee-Chest Position is used for rectal and vaginal examinations and as treatment to bring the uterus into normal position. The patient is on his/her knees with his/her chest resting on the bed and elbows resting on the bed or arms above head. The head is turned to one side.
Trendelenburg position The patient is placed flat on the back, face up, the knees flexed and legs hanging off the end of the table, with the legs and feet supported by a footboard. The table is positioned with the head 45 degrees lower than the body. This position is used prima
Safety . The Occupational Safety and Health Administration (OSHA) is responsible for the identification of the various hazards present in the workplace and for the creation of rules and regulations to minimize exposure to such hazards.
Hazards Physical ChemicalBiological
Physical Hazards Electrical Safety Regulations o Use only ground plugs that have been approved by Underwriters' Laboratory (UL). o Never use extension cords. o Avoid electrical circuit overloading. o Inspect all cords and plugs periodically for damage. o Use a s
Chemical Safety Regulations o If the skin or eyes come in contact with any chemicals, immediately wash the area with water for at least 5 minutes. o Store flammable or volatile chemicals in a well-ventilated area. o After use, immediately recap all bottles containing toxic
Biological Safety Regulations 1. Disinfect the laboratory work area before and after each use when dealing with biologicals. 2. Never draw a specimen through a pipette by mouth. This technique IS no: permitted in the laboratory. 3. Always wear gloves. 4. Sterilize specimens and
External Hemorrhage 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 cause further damage.
Shock 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.
Shock Common symptoms: • Pale, cold, clammy skin • Rapid, weak pulse • Increased, shallow breathing rate • Expressionless face/staring eyes. First Aid for Shock: • Maintain an open airway for the victim • Call for assistance • Keep the victim ly
Infection Control/Chain of Infection This consists of links, each of which is necessary for the infectious disease to spread. Infection control is based on the fact that the transmission of infectious diseases will be prevented or stopped when any level in the chain is broken or interrupted.
Infection Control Agents are infectious microorganisms that can be classified into groups namely: viruses, bacteria, fungi, and parasites.
Infection Control Portal of exit the method by which an infectious agent leaves its reservoir.
Infection Control Mode of transmission -Contact : direct and indirect Droplet -Airborne -Common vehicle -Vectorborne
Infection Control Portal of entry allows the infectious agent access to the susceptible host. Common entry sites are broken skin, mucous membranes, and body systems exposed to the external environment such as the respiratory, gastrointestinal, and reproductive.
Infection Control Susceptible host The infectious agent enters a person who is not resistant or immune.
Disinfection. This procedure used in medical asepsis using various chemicals that can be used to destroy many pathogenic microorganisms. they are used only on inanimate objects
Surgical Asepsis All microbial life, pathogens and nonpathogens, are destroyed before an invasive procedure is performed. Surgical asepsis and sterile technique are often used interchangeably.
Four methods of sterilization 1. Gas sterilization: often used for wheelchairs and hospital beds. Useful in hospitals, but costly for the office. 2. Dry heat sterilization: requires higher temperature that steam sterilization but longer exposure times. Used for instruments that easi
Isolation Precautions The CDC issued a revised guidelines consisting of two tiers or levels of precautions: Standard Precautions and Transmission-Based Precautions
Standard Precautions This is an infection control method designed to prevent direct contact with blood and other body fluids and tissues by using barrier protection and work control practices. Under the standard precautions, all patients are presumed to be infective for blood
Transmission- Based Precautions the second tier of precautions and are to be used when the patient is known or suspected of being infected with contagious disease. They are to be used in addition to standard precautions Contact precautions Airborne precautions Droplet precautions
poprslivimsq by mouth by rectumsublingualintravenousintramuscularsubcutanenous
Layers of the heart o Endocardium - the innermost layer of the heart. It forms the lining and folds back onto itself to form the four valves. It is in this layer that the conduction system is found. o Myocardium - the middle and contractile layer of the heart. It is made u
The Pericardium The pericardium is a sac in which the heart is contained. It consists of the outermost fibrous pericardium and the serous pericardium which consists of a visceral and a parietal portion.
The Heart Chambers • Right Atrium - 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. • Right ventricle - receives deoxyge
The Heart Valves: atrioventricular valves semilunar valves
atrioventricular valves (A V): 1. Tricuspid valve - located between the right atrium and the right ventricle. As the name connotes, it has three cusps. 2. Mitral valve - located between the left atrium and the left ventricle. It has two cusps and it also called the bicuspid valve.
semilunar valves Pulmonic valve - located between the right ventricle and the pulmonary trunk. Aortic valve - located between the left ventricle and aorta
Murmurs caused by diseases of the valves or other structural abnormalities.
The heart sounds are produced by the closure of the valves: s1 - first heart sound is due to the closure of the mitral and tricuspid valves. s2 - second heart sound is due to the closure of the aortic and pulmonic valves.
Vessels of the Heart The arteries supplying the heart are the right and left coronary from the aorta. The veins accompany the arteries, and terminate in the right atrium
Neural Influences of the Heart The heart is influenced by the autonomic nervous system (ANS) which is subdivided into the sympathetic and parasympathetic nervous systems. Sympathetic nervous system: affects both the atria and the ventricles by increasing heart rate, conduction and ir
Properties of cardiac cells Automaticity Excitability Conductivity Contractility
Automaticity This is the ability of the cardiac pacemaker cells to spontaneously initiate their own electrical impulse without being stimulated from another source. Sites that possess this characteristic are the SA node, A V junction, and the Purkinje fibers.
Excitability Also referred to as irritability. This characteristic is shared by all cardiac cells and it is the ability to respond to external stimulus: electrical, chemical, and mechanical.
Conductivity This is the ability of all cardiac cells to receive an electrical stimulus and transmit the stimulus to the other cardiac cells.
Contractility This is the ability of the cardiac cells to shorten and cause cardiac muscle contraction in response to an electrical stimulus. This characteristic can be enhanced through administration of certain medications, such as digitalis, dopamine and epinephrine.
Depolarization When a cardiac cell is stimulated, sodium ions rush into the cell and potassium leaks out, changing into positive the charge within. This electrical event is called depolarization and is expected to result in contraction.
Repolarization During cell recovery, ions shift back to their original places and the cell recovers the negative charge inside. This is repolarization, and proceeds from the epicardium towards the endocardium. It results in myocardial relaxation.
Conduction System of the Heart SA Node Found in the upper posterior portion of the right atrial wall just below the opening of the superior \-ena cava. It is the primary pacemaker of the heart and has a normal firing rate of 60-1 00 beats per minute.
Conduction System of the Heart Internodal pathways Consists of anterior, middle and posterior divisions that distribute electrical impulse generated by :be SA node throughout the right and left atria to the atrioventricular (A V) node.
A V Junction: AVnode Located at the posterior septal wall of the right atrium just above the tricuspid valw. There is a 1/10th of a second delay of electrical activity at this level to allow blood to flow from the atria to the ventricles.
Bundle of His Found at the superior portion of the interventricular septum, it is the pathway that leads out of the SA node. It has an ability to initiate electrical impulses with an intrinsic firing rate of 40-60 beats per minute.
Bundle branches Located at the interventricular septum, the bundle ofRis divides into the right and left bundle branches, the function of which is to conduct the electrical impulse to the Purkinje fibers.
Purkinje fibers Found within the ventricular endocardium, it consists of a network of small conduction fibers that delivers the electrical impulses to the ventricular myocardium. This network has the ability to initiate electrical impulses and act as a pacemaker if the h
Limb Leads Consist of three bipolar leads and three augmented leads. These leads record electrical potentials in the frontal plane.
Bipolar Standard Leads Lead I = the left arm is positive and the right arm is negative. (LA-RA) Lead II = the left leg is positive and the right arm is negative. (LL-RA) Lead III = the left leg is positive and the left arm is negative. (LL-LA)
Augmented Unipolar Lead They are designated as a VR, a VL, and a VF. These leads are unipolar and they require only one electrode from one limb to make a lead.
The electrocardiographic grid The EKG paper is a graph paper with horizontal and vertical lines at I-mm intervals. A heavy line appears every 5mm. The horizontal axis represents time: Imm = 0.04 seconds; 5mm = 0.2 seconds. The vertical axis represents amplitude measured in millivolts
Waves, segments and intervals • Waveform: refers to movement away from the isoelectric line either upward (positive) deflection or downward (negative) deflection. • Segment: line between two waveforms. • Interval:wa'leform plus a segment. • Complex: several waveforms
Atrial Activation: p P wave: the deflection produced by atrial depolarization. The normal P wave in standard, limb, and precordial leads does not exceed O.lls in duration or 2.5mm in height.
Ventricualr Activation: QRS QRS complex: represents ventricular depolarization (activation). The ventricle is depolarized from the endocardium to the myocardium, to the epicardium. Q (q) wave: the initial negative deflection produced by ventricular depolarization. R (r) wave: th
Ventricular Repolarization: TU T wave: the deflection produced by ventricular repolarization. U wave: the deflection seen following the T wave but preceding the next P wave.
Normal Intervals: RR RR interval: this is the interval between two R waves.
PR interval P wave plus the PR segment. The normal interval is 0.12 - 0.2 sec.
QRS interval (or duration): represents ventricular depolarization time. It should be no more th; 0.1 sec. in the limb leads and 0.11 sec. in the precordial leads
Artifacts Somatic tremors Wandering baseline 60-cycle interference Broken recording
Stress Testing Test is a noninvasive diagnostic procedure to determine the presence and severity of coronary artery disease A rhythm strip is run continuously throughout the test and a complete 12-lead EKG is recorded usually every 90 seconds during exercise and every
Exercise stress test 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 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% o
Arrhythmias Arrhythmias of sinus origin Ectopic rhythms Conduction blocks Pre-excitation syndromes
Myocardial Ischemia Ischemia occurs when there is a decrease in the amount of blood flow to a section of the heart. This is usually experienced as chest pain and discomfort and is called angina.
Infarction Infarction refers to the actual death of the myocardial cells. The hallmark of infarction on EKG is the presence of abnormal Q waves. Q waves are considered abnormal if they are:::l rnm (0.04 second) wide and the height is greater than 25% of the height o
Holter monitor This is an ambulatory EKG done to rule out intermittent arrhythmias or ischemia that could be missed on a routine EKG Five electrodes are attached to the patient's trunk instead of the arms and leg to prevent muscle artifact
Typical electrode placement for Holter monitoring: Two exploring electrodes are placed over bone (to minimize motion artifact) near the VI (over the 4th or 5th rib to the right of the sternum) and V5 (over the 5th rib at the left midaxillary line) . Two indifferent electrodes placed over the manubrium
Event Monitoring These patients are best suited for an event recorder, a hand held device carried in the patient's pocket or purse which is switched only when the patient is actually experiencing the symptom.
Common Cardiovascular Agents Oxygen Oxygen should be given to all patients with acute chest pain that may be due to cardiac ischemia, suspected hypoxemia of any cause, and cardiopulmonary arrest. Prompt treatment of the hypoxemia may prevent cardiac arrest. For patients breathing spontaneou
Common Cardiovascular Agents Epinephrine Epinephrine is indicated in the management of cardiac arrest. The chance of successful defibrillation is enhanced by administration of epinephrine and proper oxygenation
Common Cardiovascular Agents Isoproterenol (Isuprel) Isoproterenol produces an overall increase in heart rate and myocardial contractility, but newer agents have replaced it in most clinical settings. It is contraindicated in the routine treatment of cardiac arrest
Common Cardiovascular Agents Dopamine (lntropin) Dopamine is indicated for significant hypotension in the absence of hypovolemia. Significant hypotension is present when systolic blood pressure is less than 90 mmHg with evidence of poor tissue perfusion, oliguria, or changes in mental status. It should
Common Cardiovascular Agents Beta Blockers: Propranolol, Metoprolol, Atenolol, and Esmolol Beta blockers reduce heart rate, blood pressure, myocardial contractility, and myocardial oxygen consumption which make them effective in the treatment of angina pectoris and hypertension. They are also useful in preventing atrial fibrillation, atrial flu
Common Cardiovascular Agents Lidocaine Lidocaine is the drug of choice for the suppression of ventricular ectopy, including ventricular tachycardia and ventricular flutter. Excessive doses can produce neurological changes, myocardial depression, and circulatory depression. Neurological toxicit
Common Cardiovascular Agents Verapamil Verapamil is used in the treatment of paroxysmal supraventricular tachycardia (PSVT), effective in terminating more than 90% of episodes ofPVST in adults and infants. Verapamil is also useful in slowing ventricular response to atrial flutter and fibrillat
Common Cardiovascular Agents Digitalis Digitalis increases the force of cardiac contraction as well as cardiac output. Digitalis toxicity is common with an incidence of up to 20%. Patients requires constand monitoring for signs and symptoms of toxicity such as: yellow vision, nauseam vomiting
Common Cardiovascular Agents Morphine sulfate It is the traditional drug of choice for the pain ad anxiety associated with acute myocardial infarction. In high doses morphine sulfate may cause respiratory depression. It is a controlled substance and has tendency for abuse and addiction
Common Cardiovascular Agents Nitroglycerin Nitroglycerin is a powerful smooth muscle relaxant effective in relieving angina pectoris. It is effective for both exertional and rest angina. Headache is a common consequence following the administration of this drug. Hypotension may occur and patients
The circulatory system 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 such as carbon dioxide and urea to the organs (lung and kidneys, respectively) where
The blood vessels The blood vessels are: Aorta, arteries, arterioles, capillaries, venules, veins, superior and inferior vena cavae
The blood vessels anatamy The blood vessels, except for the capillaries, are composed of three layers. The outer connective tissue layer is called the tunica adventitia. The middle smooth muscle layer is called the tunica media. The inner endothelial layer is called the tunica int
Blood adult has 5 to 6 liters of blood liquid portion called the 'plasma', and a cellular portion called the 'formed elements
Plasma comprises 55% of the circulating blood and it contains proteins, amino acids, gases, electrolytes, sugars, hormones, minerals, vitamins, and water (92%). It also contains waste products such as urea that are destined for excretion.
The formed elements constitute the remaining 45% 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). All blood cells normally originate from stem cells in the b
erythrocytes contain hemoglobin, the oxygen-carrying protein. It enters the blood as an immature reticulocyte where in one to two days, it matures into an erythrocyte. There are 4.2 to 6.2 million RBC's (red blood cells) per microliter of blood. The normal life span o
leukocytes is to provide the body protection against infection. The normal amount of WBC's (white blood cells) for an adult is 5,000 to 10,000 per microliter.
Leukocytosis which is an increase in WBCs, is seen in cases of infection and leukemia.
Leukopenia, which is a decrease in WBCs, is seen with viral infection or chemotherapy
Neutrophils the most numerous, comprise about 40% to 60% ofWBC population. They are phagocytic cells, meaning, they engulf and digest bacteria. Their number increases in bacterial infection, and often, the first one on the scene
Lymphocyte the second most numerous, comprising about 20% to 40% of the WBC population. Their number increases in viral infection, and they playa role in immunity
Monocytes comprising 3% to 8% of the population, they are also the largest WBCs. They are monocytes while in the circulating blood, but when they pass into the tissues, they transform into macrophages and become powerful phagocytes. Their number increases in intrac
Eosinophil 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 account for 0% to 1 % ofWBCs in the blood. They carry histamine, which is released in allergic reactions
thrombocytes platelets) are small irregularly shaped packets of cytoplasm formed in the bone marrow from megakaryocytes. Essential for blood coagulation, the average number of platelets is 140,000 to 440,000 per micro liter of blood. They have a life span of9 to 12 da
Hemostasis is the process by which blood vessels are repaired after injury. This process starts from vascular contraction as an initial reaction to injury, then to clot formation, and finally removal of the clot when the repair to injury is done.
Hemostasis Stage 1: Vascular phase Stage 2: Platelet phase Stage 3: Coagulation phase Stage 4 - Fibrinolysis
Site Selection antecubital fossa A. Median cubital vein - the vein of choice because it is large and does not tend to move when the needle is inserted. B. Cephalic vein - the second choice. It is usually more difficult to locate and has a tendency to move, however, it is often the only
Unsuitable veins for venipuncture are A. Sclerosed veins - These veins feel hard or cordlike. Can be caused by disease, inflammation, chemotherapy or repeated venipunctures. B. Thrombotic veins C. Tortuous veins - These are winding or crooked veins. These veins are susceptible to infect
Patient Identification Ask the conscious patient to state his or her full name . In addition to checking the patient's name, check the patient's identification numbers.
Accessioning Order Each request for a blood specimen must include an accessioning order: a number to identify all paperwork and supplies associated with each patient. This unique number can be used to trace back that specimen and patient. It ensures accurate and prompt proc
The blood request forms should include the following information 1. Patient's name and age from ID plate or wristband. 2. Identification number. 3. Date and time the specimen is obtained. 4. Name or initials of person who obtains the specimen 5. Accessioning number. 6. Physician's name. 7. Department for wh
Factors to Consider Prior To Performing the Procedure: FastingEdemaFistula
Order of Draw 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. Lavender top tubes 6. Gray top tubes BeCause Blood Cultures Better Blue Specimens Serum (
Complications Associated with Phlebotomy Hematoma:Hemoconcentration: Petechiae:ThrombophlebitisPhlebitis
Hematoma : The most common complication of phlebotomy procedure. This indicates that blood has accumulated in the tissue surrounding the vein. The two most common causes are the needle going through the vein, and/or failure to apply enough pressure on the site aft
Hemoconcentration The increase in proportion of formed elements to plasma caused by the tourniquet being left on too long. (More than two (2) minutes)
Phlebitis Inflammation of a vein as a result of repeated venipuncture on that vein.
Petechiae 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 This is a blood clot usually a consequence of insufficient pressure applied after the withdrawal of the needle
Thrombophlebitis Inflammation of a vein with formation of a clot
Septicemia This is a systemic infection associated with the presence of pathogenic organism introduced during a venipuncture
Trauma This is an injury to underlying tissues caused by probing of the needle.
Two-Hour Postprandial Test This test 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 This test is used to diagnose diabetes mellitus and evaluate patients with frequent low blood sugar. 3-hour oa1T is used to test hyperglycemia (abnormally high blood sugar level) and diagnose diabetes mellitus. 5-hour oaIT is used to evaluate hypoglycem
Therapeutic Drug Monitoring This test is used to monitor the blood levels of certain medication to ensure patient safety and also maintain a plasma level. Blood is drawn to coincide with the trough (lowest blood level) or the peak level (highest blood level). Trough levels are colle
Blood Cultures (BC) They are ordered to detect presence of microorganisms in the patient's blood. The patient will usually have chills and fever of unknown origin (FDO), indicating the possible presence of pathogenic microorganisms in the blood (septicemia). Blood cultures a
Cold Agglutinins Cold agglutinins 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
Chilled specimens Some tests require that the specimen collected be chilled immediately after collection in crushed ice or ice and water mixture. Likewise, the specimen must be immediately transported to the laboratory for processing. Some of the tests that require chilled
Light-sensitive specimens 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: Bilirubin, beta-carotene, Vitamins A & B6, and porphyrins.
Dermal Punctures (Microcapillary collection) When venipuncture is inadvisable, it is possible to perform a majority oflaboratory tests on micro samples obtained by dermal (skin) puncture, with the exception ofESR, blood cultures and other tests that require a large amount of serum. Dermal puncture
Order of draw for capillary specimens 1. Lavender tube 2. Tubes with other additives 3. Tubes without additives
Lavender top tube Contains the anticoagulant ethylenediaminetetraacetic acid (EDT A). EDT A inhibits coagulation by binding to calcium present in the specimen. The tubes must be filled at least two-thirds full and inverted eight times
Coagulation Studies CBC (Complete Blood Count); Includes: RBC count, WBC count and Platelet count; WBC differential count; Hemoglobin and Hematocrit determinations; ESR (Erythrocyte Sedimentation Rate); Sickle Cell Screening Prothrombin Time (PT) - evaluates the extrinsi
Light-Blue top tube Contains the anticoagulant Sodium Citrate, which also prevents coagulation by binding to calcium in the specimen. Sodium citrate is the anticoagulant used for coagulation studies because it preserves the coagulation factors. The tube must be filled comple
Green top tube 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 s
Chemistry tests performed on plasma such as Ammonia, carboxyhemoglobin & STAT electrolytes.
Gray top tube Contains additives and anticoagulants. All gray top tubes contain glucose preservative (antiglycolytic agent): sodium fluoride- preserves glucose for 3days; or lithium iodoacetate- preserves glucose for 24 hours. May also contain the anticoagulant potassi
Fasting blood sugar IFBS Glucose tolerance test (GTT); Blood alcohol levels; Lactic acid measurement
Red/Gray (speckled) top tube Also called tiger-top tube and serum separator tubes (SST). 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 c
Red top tube- Also known as plain vacuum tube and contains no additive or anticoagulant. Collected blood clots by normal coagulation process in 30-60 minutes. There is no need to invert the tube after collection. Common tests - Serum chemistry tests; Serology tests;
Yellow top tube - (sterile) Contains the anticoagulant sodium polyanetholesulfonate (SPS). These are used to collect specimens to be cultured for the presence of microorganisms. The SPS aids in the recovery of microorganisms by inhibiting the actions of complement, phagocytes, and c
Standards This is a substance of known value essentially free of impurities and have close to a "true" value
Proficiency Testing Systems Proficiency testing systems are a requirement for laboratories. State, local or private agencies send sera to the laboratories for testing, the results of which are sent back to the agencies. Test results are compared with those of other participating lab
Maintenance Programs Maintenance schedule for all laboratory instruments must be in place so that they stay in correct working condition. Maintenance activities include regular calibrating of instruments, checking refrigerator and freezer temperature, water purity testing to
Hematology Section This department deals with the various components of the blood: white blood cells, red blood cells, platelets. Tests performed may be quantitative which involve actual number counts. Complete blood count is the most common test performed. Tests
Chemistry Section • Electrophoresis - analyzes chemical components of blood such as hemoglobin and serum, urine and cerebrospinal fluid, based on the differences in electrical charge. • Toxicology - analyzes plasma levels of drugs and poisons. • Immunochemistry - This
Blood Bank Section This is the section where blood is collected, stored and prepared for transfusi . Blood collected may be separated into components: packed cells, platelets, fresh frozen plasma, and cryoprecipitate. The most common testing done includes ABa and Rh typi
Specimen Requirements Patient's full name and date of birth Patient's hospital identification number (SSN for outpatients) Date and time of collection Phlebotomist's initials
Standards This is a substance of known value essentially free of impurities and have close to a "true" value
Proficiency Testing Systems Proficiency testing systems are a requirement for laboratories. State, local or private agencies send sera to the laboratories for testing, the results of which are sent back to the agencies. Test results are compared with those of other participating lab
Maintenance Programs Maintenance schedule for all laboratory instruments must be in place so that they stay in correct working condition. Maintenance activities include regular calibrating of instruments, checking refrigerator and freezer temperature, water purity testing to
Hematology Section This department deals with the various components of the blood: white blood cells, red blood cells, platelets. Tests performed may be quantitative which involve actual number counts. Complete blood count is the most common test performed. Tests
Chemistry Section • Electrophoresis - analyzes chemical components of blood such as hemoglobin and serum, urine and cerebrospinal fluid, based on the differences in electrical charge. • Toxicology - analyzes plasma levels of drugs and poisons. • Immunochemistry - This
Blood Bank Section This is the section where blood is collected, stored and prepared for transfusi . Blood collected may be separated into components: packed cells, platelets, fresh frozen plasma, and cryoprecipitate. The most common testing done includes ABa and Rh typi
Specimen Requirements Patient's full name and date of birth Patient's hospital identification number (SSN for outpatients) Date and time of collection Phlebotomist's initials
Rh Blood Group System The presence or absence of the "D" antigen (also known as the Rh factor) on the RBC membrane determines whether a person is Rh positive or negative.
Serology (Immunology) Section Performs tests to evaluate the patient's immune response through the production of antibodies. This section uses serum to analyze presence of antibodies to bacteria, viruses, fungi, parasites and antibodies against the body's own substances (autoimmunity)
Microbiology Section 1. Bacteriology - the study of bacteria 2. Parasitology - the study of parasites 3. Mycology - the study of fungi 4. Virology - the study of viruses
Urinalysis Section This department performs physical, chemical, and microscopic examination of urine
Meter The meter is the basic unit of length.
Liter e liter is the basic unit of capacity or volume.
Gram The gram is the basic unit of weight or mass.
Preparing Solutions and Dilutions Desired strength = X (amount needed)Available strength amount available
Arterial Blood Gas Studies ABGs help assess a patient's ventilation, oxygenation, and acid-base balance.
The Gram Stain The most important bacterial property for classification purposes is a simple procedure that employs the aniline dye, crystal violet. The cell wall structure appears to be the determining factor by which bacteria react to the Gram stain. Gram-positive b
The Gram staining procedure consists of the following sequence: • Dye - crystal violet • Mordant - Gram's iodine • Decolorizer - 95% ethyl alcohol/acetone mixture • Counterstain - safranin stain
Smear Preparation A smear can be from any body opening, including the genitals or wounds (such as surgical sites, bites, cuts, or body ulcers). The best process is to obtain two swabs, one for the culture and one for the smear. If this is the case, the specimen is cultured
Smearing and Fixation Technique Smears should be air-dried on a flat surface or on an electric slide warmer heated to 60 degrees Centigrade. The slide is placed on the supporting rods of the stain rack and then fixed by covering the slide with methanol for I minute. The residual methano
Staining Bacteria staining procedure involves the sequential application of primary stain mordant, decolorizer, and counterstain to a bacterial smear. The stain is allowed to remain in one place for 30
Staining of Blood Smears The stain commonly used for examination of blood cells is called polychromatic because they contain dyes that will stain various cell components different colors. These stains usually contain methylene blue, a blue stain, and eosin, a re-orange stain. The
Components of the urinary system kidney is the primary organ of the urinary system. Urine flows from the collecting ducts to the renal pelvis and through the ureter into the bladder.
kidneys' functions to remove metabolic waste from the blood stream, maintain the body's acid-base balance and regulate body hydration. Urea, a nitrogenous product of protein metabolism, is the major waste product removed by the kidney
Urine Output The actual amount of urinary output is dependent upon the body's state of hydration and normally averages l200-1500ml every 24 hours. Decreased urinary output is termed oliguria. Increased output is called polyuria, and little or no urine output is known
Chemical examination of urine pH Glucose Ketone Protein Blood Bilirubin Urobilinogen Nitrite Leukocyte esterase
Microscopic examination of the urine This is the microscopic examination done on urine sediment obtained by centrifugation of 10 to 15mlofurine.
Specific Gravity The specific gravity of urine is the ratio of the weight of a given volume of urine to the weight of the same volume of distilled water at a constant temperature. Specific gravity is the most convenient way of measuring the kidneys' ability to concentrate
Urinary pH The pH, or the percentage of hydrogen ion concentration of a solution, is a reflection of the acidity or alkaline of a solution. A pH of7.0 is considered to be neutral. The pH of distilled water is 7.0. A pH of 0 to 7.0 is considered to be acidic, whereas
Urinary Glucose . The reagent strip test for glucose relies on enzymatic tests that are specific for glucose. A common reagent strip urinary glucose enzymatic method uses glucose oxidase.
Urinary Bacteria 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.
Urinary Leukocytes The presence of increased numbers of leukocytes or white blood cells in the urine is an indicator of bacteriuria or urinary tract infection (UTI). Granulocytic leukocytes release esterase when the cells lyse. Testing for leukocy1e esterase by the reagent
Specialized Urine TestslUrinary Pregnancy Testing Probably the most common specialized urine test is the pregnancy test. Human chorionic gonadotropin (hCG), also known as uterine chorionic gonadotropin (UCG), is produced in the placenta and is detectable in the blood and urine early in the gestation peri
Negligence 1. Duty: duty of care 2. Derelict: breach of duty of care 3. Direct cause: legally recognizable injury occurs as a result of the breach of duty of care. 4. Damage: wrongful activity must have caused the injury or harm that occurred
Tort Is a wrongful act that results in injury to one person by another
Tort Battery Defamation of character Invasion of privacy Good Samaritan Law This law deals with the rendering of first aid by health care professionals at the scene of an accident or sudden injury.
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