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CPT-1 Final Exam


What is ASPT American society of Phlebotomy Technicians (national certifying organization)
What is AMT American Medical Technologist (national certifying organization)
What is ASCP American Society of Clinical Pathologist (national certifying organization)
What is NPA National Phlebotomy Association (national certifying oranization)
What is NCCT National Center for Competency Testing (National certifying organization)
What is NHA National Healthcareer Association (national certifying organization)
How many CEU units do you need every two years to renew your state phlebotomy license? 6 Continuing education units
Define Certification Issuance by an official body of a certificate to a person indicating that he/she has met certain requirements
define Licensure legal permission grated by the state to engage in an occupation or activity
define Reciprocity One state recognizes the licensure granted by another state
Define integrity Dedicated to maintaining high standards
define empathy ability to understand another's feelings
define discretion use of good judgement and prudence
define diplomacy use of tact and understanding
define confidentiality ability to safeguard patient privacy
define ethics moral duty to determine the difference between right and wrong
define honesty always telling the truth regardless of the situation
communication skills verbal, non verbal, and active listening
define compassion a gentle caring attitude
define dependability being punctual and completing tasks in a timely manner
define accountability being responsible for your actions
what does the LABORATORY DIRECTOR do interprets results to diagnose disease...can be a pathologist or bioanalyst
what does the LABORATORY ADMINISTRATOR or AKA MANAGER do Day to day operations of lab... liaison between director and lab staff
What do TECHNICAL SUPERVISORS do daily work schedules and staffing ...
Define CLS Clinical laboratory scientist
What does CLS do Directs work of other lab staff...MAINTAIN QA standards ...
How do you become a CLS 4year med tech program, 1yr. internship, board exam
What is MLT Medical laboratory technicians
What are CLT Clinical Laboratory tecnicians
What do MLT/CLT do test BLOOD, URINE, abnormal test values, train new employees..2YR trainins in medical lab program, certification for approved agency
What are the major divisions within laboratory departments Clinical analysis...Surgical/anatomical pathology
What is the purpose of the chemistry dept. Makes test more efficient and quality assurance testing more accurate ...(ITS THE LARGEST DEPARTMENT)
What is the purpose of microbiology dept. Analyzes for presence of microorganisms Ex. of tests C&S , GRAM STAIN TEST
What is the purpose of the immunology/serology dept. Determines the antigen-antibody reaction of the body (identifies bacterial growth in blood culture bottles)
What is the purpose of the blood bank dept. Blood typing and antibody tests..Blood from donors is tested here before being used for transfusions ..THE MAKE NO MISTAKES
what is the purpose of the Urinalysis dept cam be performed in sevaral areas of the lab 3parts..PHYSICAL, CHEMICAL, MICROSCOPIC ex. of test....CLEAN CATCH SPECIMEN TEST
CLSI use to be called what NCCLS National Committee For Clinical Laboratory Standards
What is CLSI Clinical Laboratory Standards Institute
What does CLSI do Establishes prcedural guidelines for all areas of the lab(GOLD STANDARD)
What is CAP College of AMerican Pathologists
What does CAP do Sets standards for phlebotomy ...Proficiency testing/lab testing by pathologist and CLSs.....Compares results to labs across country
Define JCAHO Joint Commission on Accreditation Of Health care organization
What is the purpose of JCAHO Accrediting agency for hospitals and nursing homes ..inspects every two years ..ENFORCE STANDARDS ESABLISHED BY CLSI ..WORKS WITH CAP to provide lab accreditation
Define CLIA Clinical Laboratory Improvement Act of 1988
What is the purpose of CLIA Enacted by congress to regulate all labs..Include guidelines ...QUALITY CONTROL..QUALITY ASSURANCE...RECORD KEEPING,,PERSONAL QUALIFICATIONS NO AN ORGANIZATION
What is the objective of CLIA program ENSURE QUALITY LAB TESTING
What is an Infection Invasion of the body with pathogenic(diease causing) bacteria, fungi,viruses, protozoa or parasites
What is the primary goal of infection control program Reduce the risk of endemic and epidemic infections in patients personnel and visitors
Define Bloodborne Pathogen Pathogenic Organisms in blood that cause disease
define parenteral Piercing mucous membranes or skin barriers
What is the CHAIN OF INFECTION Infectious Agent...Reservoir..Exit Pathway..Means of Transmission...Entry Pathway..Susceptible Host
Define Pathogen disease causing organism
give ex. of an infectious agent Becteria, fungus, protozoon, rickettsia, virus
give ex. of RESERVOIR animal, human, equiment, food, soil, water
give ex. of EXIT PATHWAY Blood,exudates, excretions, secretions
give ex. of MEANS OF TRANSMISSION airborne, contact, droplet, vector, vehicle
give ex. of ENTRY PATHWAY body orficies, mucous membranes, broken skin
give ex. of susceptible host elderly, newborn, acute/chronically ill patients, immune suppressed unvaccinated
What is a NOSOCOMIAL INFECTION infection acquired AFTER a person has enetered a hospital, clinic, nursing home, or rehab faciility
What is a common nosocomial infection UTI ..Urinary tract infections
Standard/Universal precautions is enforced by OSHA and established by CDC .center of disease control
you should change your gloves every 30min
to disinfect equipment and surfaces use 1:10 bleach solution
What are the body's natural barriers Skin and mucous membranes
define STRICT ISOLATION for HIGHLY contagious disease.EX. HIV.
Define Enteric Isolation For patients with intestinal infections
define Contact Isolation for patients with diseases that can be spread by direct contact ..ex MRSA,VRE, and C. Difficile
define Protective/reverse/neutropenic isolation for non infectious patiets who may be susceptible to infection..ex..Geriatric patients.. newborns
define Airborne isolation for patients with diseases spread by droplets that are smaller than 5micrometers example of diseases (TB) Varicela zoster (chicken pox) and measels (SPECIAL REQUIRMENT.NEGATIVE PRESSURE ROOM)
define droplet isolation for patients with diseases spread droplets that are larger than 5 micrometers (example PERTUSSIS..meningitis, German measles
What is OSHA occupational Safety and health administration
What is the purpose of OSHA Assures every person safe and healthful working conditions (FEDERAL AGENCY)
If a glass is broken you should remove it with a DUST PAN
Sharp containers should be replaced when they are 2/3 full
what is the function of the Adrenal Glands Prodeuce hormones .EPINEPHRINE and NOR EPINEPHRINE...located on top of each kidney
what is the function of the ALVEOLAR SACS Aloow for diffusion between air and blood
What is Amoiotic fluid Fluid from the AMONIOTIC SAC
what is the AORTA Largest artery in the body
what are ARTERIES Blood vessels that carry blood away from the heart
what are the ARTERIOLES Smaller branches of the arteries
What is the ATRIA Upper chambers of the heart
What are Blood vessels The transport blood ..Include ARTERIES ARTERIOULES CAPILLARIES VENULES and VEINS
What are capollaries Microscopic, Unicellular blood Vessels linking arteriols to venules
What does the INFERIOR VENA CAVA do? Brings deoxygenated blood to the heart from lower parts of the body
What does the lymphatic system do Maintains fluid balance, defends against disease, absorption of fats from blood stream
what is PERITONEAL FLUID fluid from the abdominal cavity
What is PLEURAL FLUID fluid from the lung cavity
What is the function of the superior vena cava Brings deoxygenated blood from the head, neck, chest region of the heart
What is SYNOVIAL FLUID fluid from joints
what do veins do carry deoxygenated blood towards the heart
what are venules smaller branches of veins
what are ventricles they are the lower chambers of the heart
what is BLEEDING TIME test to assess PLATELET PLUG formation in CAPILLARIES (pre surgical)
What is BUFFY COAT after centrifuation of a specimen mixed with an anticoagulant, the layer between the plasma and erythrocytes..CONTAINS WBC and PLATELETS
what is a DIFFERENTIAL TEST a test that categorizes blood cells and abnormalities present
what does EDTA do prevents blood from clotting by binding calcium
Hematocrit is also known as PCV ..Packed cell volume
what are MONOCYTES Largest Leukocyte...Assist in IMMUNE SYSTEM
What is plasma it is the liquid portion of whole blood
what is platelets blood cells that aid in blood clot formation
what is serum it is the liquid portion of CLOTTED blood
Define Hematoma Localized leakage of blood into tissues (most common complication of phlebotomoy)
define OCCLUDED VEIN Closed or constricted vein
Define Sclerosed Vein Vein that becomes hardened (possible due to fatty deposits)
Define Bactermia Presence of bacteria in the blood
What is the purpose of C&S test a test to identify the microorganism and the antibiotic most effective for treamtent
define O&P ova and parasites
define Septicemia Presence of bacterial toxins
define ACIDOSIS condition when blood pH is below 7.35
define ALKALOSIS condition when blood is pH is above 7.45
What is a BUN TEST test to determine amount of urea in blood
define LIPEMIC Cloudy/milky appearance of serum due to excessive lipid content
what is POST PRANDIAL GLUCOST TEST glucose test performed after ingestion of a meal
what is the PREANALYTICAL PHASE when tests are ordered and specimens are collected and prepared for testing
define TDM therapeutic drug monitoring
what is the purpose of Citrate keeps blood from clotting by binding calcium
define fibrin substance that makes up a clot
what is the purpose of heparin the green tubes prevents blood clotting by inactivating thrombin and prothrombin
what is BASAL STATE patients condition early in the morning.. 12hour after last ingestion of food (fasting)
define DHS department of Health Services
What is a Fistula an artificial shunt or passage(vein and artery fused together)
define Hemolysis rupture of erthrocytes
define metabolic acidosis condition when the kidneys cannot eliminate acid substances (can cause renal failure)
define metabolic alkalosis condition resulting from excessive vomiting or an abnormal secretion of certain homrmones that cause excess elimination of hydtogen ions (too much base and not enough acid)
what is the purpose of OSHA Ensures a safe working environment
what is the purpose of QC quality control daily control used in analytic testing to determine accurace in precision
define QNS quantity not sufficient
If you leave a tourniquet for more than one minute it can cause Hemoconcentration
define ANATOMY study of the structure of an organism
define Physiology Study of how the body functions
define Pathophysiology Study of disease and how it affects the body
Why do we need to draw blood provided information about vital bodily function
Blood is the primary means of transport for Nutrients, waste, oxygen, carbon dioxide, and hormones
What should a blood draw ALWAYS start with a REQUISITION
a requisition can be written in what ways Hand written, preprinted or computer generated
what information may not be found on a requisition patient diagnosis ...patients gender...patients billing information ..
If any doubts at any time of a tube what should you do DISCARD
what are the 3primary methods for venipuncture Evacuated tube method (straight needle)....Butterfly Method...Syringe Method
Additives are usually either ..? anticoagulant or preservative
Light Blue Tube ANTICOAGULANT: sodium citrate Prevents coagulation by binding Ca+ ex. of test....PT, PTT
RED TUBE (Serum Tube) No additive ..Commonly Requested tube .. (SEROLOGY, SERUM CHEMISTRY TESTS) ex. of test Cholesterol
Tiger Top (SST) Clot Activator ...Gel Separator -SST=Serum separator tube ..(SEROLOGY, SERUM CHEMISTRY
Gold (SST) Clot Activator..Gel Separator (SEROLOGY, SERUM CHEMISTRY TESTS)
Green Tube Anticoagulant: Sodium Heparin, Lithium heparin, or Ammonia heparin ...Prevents coagulation by inhibiting the action of THROMBIN(a clotting factor) (PLASMA CHEMISTRY TEST)
Lavender Tube Anticoagulant: Sodium or K+ EDTA ..Prevents clotting by binding Ca2+ ..Prevents platelet aggregation (clumping) ..Preserves the shape of the cells ..CANNOT be used for coagulation studies Tests: CBC (HEMATOLOGY STUDIES) "preserves glucose up to 5d
Gray Tube Contains an anticoagulant and a preservative .. Anticoagulant=POTASSIUM OXALATE Binds Ca2+..Preservative: SODIUM FLOURIDE ..Ihibits the glycolytic activity in cells .. Tests collected EX. Glucose, ETOH (CHEMISTRY TEST)
Pink Tube Additive: anticoagulant EDTA (USED FOR BLOOD BANK)
Black Tube Additive: Anticoagulant Sodium Citrate.. Used for:WESTERGREN SEDIMENTATION RATE "4:1 Ratio"
Dark Blue Tube Additive: either no additive, sodium heparin, or EDTA ... Used for trace metal assays "TOXICOLOGY STUDIES"
Brown Tube Additive: anticoagulant Heparin Used for: Lead Testing
Yellow Tube additive: anticoagulant SPS.. Used for Blood Cultures MUST BE STERILE
what is HEMATOLOGY study of blood and blood forming tissues (includes are of hemostasis)
average person has how many liters of blood 5.5-6 liters
Blood has to part ..which is ? liquid portion-plasma .....Cellular portion-RBC ,WBC, Platelets(thrombocytes)
what is a routine hematology test? CBC complete blood count
What is Erthrocyte Sedimentation Rate ESR they measure the rate that RBCs fall to the bottom of a tube (also monitor inflammation and tissue injury)
what are the 4 main tests to determine hemostasis? Platelet count test...Bleeding time test...PT test (PROTHROMBIN TIME)...aPTT/PTT test
What are some specialized Chemistry Areas Toxicology (TDM and OD)..ABG..Serology ..
Random specimen is collected when ? any time of the day
First Voided specimen is collected when? in the morning as soon as the patient wakes up
Timed specimen must be collected when? usually 8-24hrs ..
Clean-catch midstream specimen patients are required to cleanse the urethral area with castile soap and towelette..first portion of urine ..urinate in tiolet then after in cup ..
A 24hr urine specimen must be collected in ? a 2000mL graduated cylinder
What are RARE complications of venipuncture Cardiac arrest...Hemorrhage ...Reflex arteriospasm...infection
taking 10ml of blood from a PREMATURE infant leads to a decrease percentage of what blood volume 5-10%
What is the reason for a dermal puncture on an adult Suitable vein cannot be found
When is skin puncture inappropriate when patient is ..severly dehydrated ..has bad circulation
Most common size for adults on a skin puncture is 2.4mm
skin puncture size on premature infants are 0.85 to 3.0mm
Swollen areas are avoided for a venipuncture because due to accumulation of tissue (interstitial) fluid
If a bone is punctured what may occur Osteomyelitis (inflammation of bone or bone marrow, usually due to infection)
what are the two most commonly used finger sites on adults for a fingerstick 3rd and 4th fingers towards tip of finger
Why is the index finger not used for a finger stick causes calluses and discomfort
What is the CAPILLARY ORDER OF DRAW Blood gases, EDTA tubes, Other additive tubes, Serum tubes
What is the appropriate depth lancet for this size of infant: 1-2kg(2.2-4.4 lbs.) 0.75-1.0mm
What is the appropriate depth lancet for this size of infant: 2-3 kg (4.4-6.6 lbs.) 1.0-2.0mm
What is the appropriate depth lancet for this size of infant: 3 kg (6.6 lbs.) or greater 2.0-2.4mm "GREATER THAN 2.4mm MAY CAUSE OSTEOMYELITIS AND PERMANENT DAMAGE TO THE INFANTS FOOT"
What is the use of EMLA Eutectuc Mixture of local Anesthetic, is used to relieve pain
Hematomas occur when blood leaks from vein or capillaries and collects in tissues around puncture site
Removal of tourniquet AFTER removal of needle can cause a Hematoma
What is PETECHIAE Tiny red spots that appear under the skine and sign of platelet defects or week capillary walls (can be an indication of broken/bruised capillaries)
the cause of Petechiae can be sign of what kind of allergy Possible latex allergy
Who should you contact if bleeding does not stop after 5min Contact physician or nursing staff
Excessive bleeding can be due to what type of anticoagulants Coumadin, Heparin (patient can have excessive bleeding as well due to clotting disorders)
Mastectomy patients are highly susceptible to ..? INFECTIONS
In Mastectomy patients, due to edema some tests may be Altered
If a patient has double mastectomy (each on one arm) ..what site would you perform a venipuncture back of hands, legs, or a fingerstick (consult physician first)
Edema Abnormal accumulation of fluid in the intracellular spaces of the body
The heart is the size of a ..... ?? Mans fist
What is the normal heart rate of an adult 60-80 times/min
What is the SEPTUM Wall the separates the heart into right and left sides
what is the Pericardium outer double walled sac to prevent friction
Right atrium fills with blood from ...? the Superior and Inferior Vena Cava
the LEFT ATRIUM filles with blood from the Pulmonary vein
Contraction of he heart pushes blood into the...? Ventricles
the left and right atria are separated by Interatrial septum
Ventricles receive blood from ATRIA
Contracitons of the heart pushes what out Blood
The right ventricle pushes blood through the Pulmonary artery
The left and right ventricles are separated by the interventricular septum
Sinoatrial (SA)node "pacemaker" causes ? wave of impulses through muscle of atria (where heart begins)
What is the function of the ATRIOVENTRICULAR (AV)Node sends impulses goes down the bundle of his-> R & L bundle branches ->Purkinje fibers-> Ventricles
Define Diastole Relaxation phase of the cardiac cycle (VENTRICLES ARE FILLING WITH BLOOD FROM THE ATRIA)
The heart is controlled by The autonomic nervous system
Bradycardia is considered at what heart rate BELOW 60
Tachycardia is considered at what heart rate Above 100
Tunica Adventitia is Thick outer layer, mostly connective tissue (prevents rupture or bursting due to increased pressure)
Tunica Media is Middle layer, smooth muscle and elastic fibers (helps maintain normal blood pressure;able to contrict)
Tunica Intima is Inner layer, single later of endothelial cells, connetive tissue, and elastic fibers (smoothness prevents abnormal blood clotting)
Adult men have about how much blood 5-6 liters of blood
how much blood does an adult women have 4-5 liters of blood
whole blood is composed of approximately....? 2.8(55%) of plasma and 1.9 liters (45%) of cells
Plasma is composed of 90% water and 10% solid materials
Serum is composed of same components as plasma EXCEPT FIBRINOGEN
What color is ICTERIC (liquid component) Dark green/yellow
What color is HEMOLYZED (liquid component) Pink/Red
What color is LIPEMIC )liquid component) Milky/creamy/cloudy
Erthrocytes have a life spam of 120days (circulating RBC have no nucleus)
Neutrophils are PHAGOCYTES..they are the first responders to infection and have 3-5 lobed nucleus (fine light blue cytoplasmic granules) "45-70% in the body"
Eosinophils are Bright RED/ORANGE cytoplasmic granules with a BILOBED NUCLEUS.. they INCREASE IN ALLERGIC REACTIONS AND PARASITIC INFECTIONS "0-5% percentage in the body"
Basophils are DARK PURPLE-BLUE cytoplasmic granules..they have irregular S-shaped nucleus and dduring inflammation it releases histamine to dialte blood vessls(granules contain heparin and histamine) "0-1% in the body"
Lymphocytes are Non-granular blue cytoplasm...LIGHT BRIGHT PURPLE NUCLEUS..2types T-destroy foreign material..B-produce antibodies to fight infection "20-40% in the body"
Monocytes are Non-granular cytoplasm...KIDNEY BEANED SHAPED..PURPLE NUCLEUS ....phagocyte and becomes macrophage is the LARGEST WBC ..."4-10% in the body"
What is the function of a THROMBOCYTE it retracts after blood clot has formed ..transports needed chemical for clotting has a life span of 9-12days
what is an antibody A substance that is produced by the body in response to an antigen
RBCs with A antigen = Type A ...plasma has antibodies to B antigen 40%common
RBCs with B antigen = Type B... plasma has antibodies to A antigen 10% common
RBCs with A and B antigen = Type AB ... plasma has NO antibodies to A or B antigens .. 4% common
RBCs without A or B antigen = Type O... Plasma CONTAINS antibodies to A and B antigens ..46% common
PRESENCE of D antigens designatedd as Rh+
ABSENCE of D antigeens designate as Rh-
Define break of duty neglect or failure to perform an obligation
Define patients bill of rights Rights that every patients has while undergoing treatment
define Stature of limitation the period after the incident that a patient has to file a lawsuit (may begin after the problem is discovered)
define TORT wrongful act(other than breach of contract) .."committed against another person or property"
define standard of care The ordinary skill and care that medical practitioners such as physicians, nurses and phlebotomists must use that is commonly used by other medical practitioners when caring for patients
define Negligence Failure to perform professional duties in accepted standard of care
deinfe Proximate cause Natural continuous sequences of events, without an intervening cause, that produces an injury • Also referred to as direct cause
define Res ipsa loquitur Latin phrase that means “the thing speaks for itself” • This is a doctrine of negligence law
define Respondeat superior Latin phrase that means “let the master answer” • This means that the physician or employer is responsible for the acts of the employee
what are the three branches of government Legislative, executive, and judicial
what are the three levels of law – Federal – State – Local
what is negligence • Violation of duty to not exercise reasonable skill and care when performing a task • Failure to perform professional duties in an accepted standard of care
what is MALPRACTICE BAD PRACTICE ...Professional negligence, improper or unskillful care of a patient
What are the 4D's if Negligence – Duty – Derelict – Direct Cause – Damage
If a phlebotomist becomes infected with HIV during employment, he/she will be covered by Worker’s Compensation Benefits
What is HIPPA • Health Insurance Portability and Accountability • Protects the privacy and security of a person’s health information when that information
In order for a provider to use or disclose PHI, the hospital/lab must give each patient a “Notice of Privacy Practices” ..Describes how the hospital/lab may use and disclose the patient’s PHI
what are the 3 catergories that CLIA divides lab into: Waived (level I)....Moderate (level II)...High (level III)
What is WAIVED (level I) • Simple testing that requires minimum judgment or interpretation • Incorrect test results pose little risk for the patient • Examples – Dipstick urinalysis – Pregnancy testing
What is MODERATE (level II) • Moderate complexity of testing • 75% of all lab tests • Certified by approved accrediting agency • Requires MLT or higher discipline • Must meet quality assurance standards
What is HIGH (level III) • High complexity of testing • Highly sophisticated tests • High risk to patient if there is an incorrect test result • Certified by approved accrediting agency • Requires CLS or higher discipline • Must meet quality assurance standards
Most frequent reason for rejection in hematology is Improperly mixed tubes causing clots in EDTA microtubes
a specimen for sedimentation rate is only stable for...? 4hrs at room temperature and 12hrs refrigerated
What is MINOR MISLABELING Truncated (cut off/shortened/abbreviated) name or medical record number, misspelled name, missing information as date and signature
what is MAJOR MISLABELING Unlabeled specimens; mismatched information on specimens and requisitions; ABO/Rh results on current specimen not matching historical record on file • This category is known as Wrong Blood in Tube (WBIT)
56% of lab errors occur during what phase During the Pre-Analytical Phase of testing
What is the most potentially fatal pre-analytical error Improper patient identification
An impatient should be asked to state his/her name, address, DOB and or unique ID number according to whos standards CLSI (Clinical Laboratory Standards Institute)
Fasting specimens should be collected around how many hours? 10-12 hours of complete fasting
How long do you pre-warm a site for capillary collection 3-5minutes (can cause increased blood flow to the area SEVENFOLD
The ORDER OF DRAW is suggested by CLSI
What happens if you under-fill a EDTA TUBE? you result with RBC SHRINKAGE
What happens if you under-fill blue top tubes You result with ELEVATED PT
What two analytes must be protected from the light? -BILIRUBIN -CAROTENE
aPTT should be tested within...? 4 HOURS
PT can remain stable for up to...? 48 HOURS (at room temperature)
Blood cultures are essential in the diagnosis of .. ENDOCARDITIS
Why are blood cultures done? To detect the presence of bacteria or yeast
What happens if a patient comes back with a positive blood culture? Physician might put the patient on broad-spectrum antibiotics, OFTEN I.V.
Septicemia may cause...? Fever, chills, shock, tachycardia, hypertension
50% of all positive blood cultures may be positive due to the process of CONTAMINANTS
Intravascular Organisms come from infected organs, cavities, fluids (CSF, synovial fluid, pericardial fluid), untreated superficial wounds, abscesses, U.T.I., or Respiratory infections
Extravascular Vascualr access devides(atrial lines, central venous catheters, etc.) urinary catheters, needles, etc
Define TRANSIENT BACTEREMIA Bacteria that exist momentarily in the bloodstream and then are engulfed by the cellular immune response
High risk contamination rates are an example of Vascular access devices, arterial lines, central venous catheters, and heparin locks
Define edema Swelling accumuation of fluid in the intercellular spaces of the body (FLUID IS INTRACELLULAR)
Hematoma (Bruise) ..Caused by the leakage of blood from veins and capillaries that collects the tissues (Blood accumulation)
Masectomies are usually accompanied by ... REMOVAL OF LYMPH NODES (high susceptibility to infections)
Sclerosed Veins Hardened Veins...due to inflammation, Disease, Repeated punctures (may be difficult to push the needle though)
If both arms have an IV, obtain the blood specimen ....? BELOW the insertion point ofthe IV LINE
PKU tests are done to..? rule out a hereditary metabolic disorder
If BILIRUBIN levels are too high babies are placed on...? UV LIGHT
EACH newborn is kept in an ISOLETTE
Newborns are extremely susceptible to ...? INFECTIONS
Always remove supplies from the isolette, ESPECIALLY ..? LANCETS
For children under two, ______puncture is the method of choice DERMAL
Heel Punctures are considered for Children under 1year/20pounds
Finger punctures are considered for Children from 1-2years
Children over 2 may have what type of puncture VENIPUNCTURE
Most elderly develop what type of anemia due to continuous phlebotomy LATROGENIC ANEMIA
EPA (environmental protective agency) recommends noise level in hospitals not to exceed ...? 40dB
Dialysis is performed on patients with END STAGE RENAL DISEASE
What happens during dialysis Waste products are removed from the blood
Venipunctures are prohibited from dialysis patients therefore you must perform..? a FINGER STICK
How many identifiers is recommended for an outpatient? 2 Identifiers
Its against "______regulations" to palpate a vein without gloves OSHA
Tourniquet must be applied how many inches apart from the antecubital fossa 3-4inches (restricts bloods flow, causes veins to distend)
Why should you allow chlorhexidine to dry completely before beginning a venipuncture To prevent Hemolysis
You should insert a needle at what angle 15-30 Degree angle (BEVEL UP)
All tubes with additives must be properly mixed as quickly as possible to prevent...? PLATELET CLUMPING AND COAGULATION
Examples of special handeling regarding "KEPT COLD SPECIMEN" include: Blood gases..ammonia
Examples of special handeling regarding "KEPT WARM SPECIMEN" include: Cold Agglutinins
Examples of special handeling regarding "KEPT IN THE DARK SPECIMEN" include Bilirubin...Carotene
What are some examples of Adverse Reaction Syncope...Nausea...Vomiting
If bleeding continues for more than 5minutes call PHYSICIAN
What are some communication strategies Verbal communication Nonverbal communication Active Listening
What are the "Four Components Of Communication" -THE SENDER(Person sending the message) -MESSAGE SENT(What the sender wants to convey) -SYMBOLS(How the sender communicates the message) -MESSAGE RECEIVED(How the message is perceived)
What is the measurement considered for "PERSONAL SPACE" 18in.-4ft. (Interactions with friends and some patients)
What is the measurement considered for "SOCIAL SPACE" 4ft.-12ft. (Most interactions of daily life)
What is the measurement considered for "PUBLIC SPACE" >12ft. (lectures, speeches)
What is the "Zone of Comfort" Area around patient that is private territory(CHILDREN may feel uncomfortable if you get to close)
What is the "GOLDEN RULE" Treat patient as you would want yourself or a family member treated in a health care setting
What is "Culture Sensitivity" System of values, beliefs and practices that stem from a person's concept to reality
Physical Impact of Stress can cause? -Hypertension -Hyperglycemia -Stroke -Myocardial Infarction -Diabetes -Ulcers -Neck and back pain
What are the early signs of stress Headaches/fatigue (due to burnout and overload)
Immediate physical signs of stress are? -Cold -Nervousness -Tense -Sweaty Hands
What are some coping strategies for stress -keep caffeine to a minimum -try not to use alcohol/nicotine(may increase level of stress) -exercise regularly -set aside time to relax each day
define ethics Morales duty to determine right and wrong
define accountability You are responsible for your actions
Define Hemophilia Tendency to bleed
define Thrombophilia tendency to clot
Define Hemostasis Process of blood clotting and then the subsequent dissolution of the clot following repair of injured tissue
What are the 5 Steps of the hemostatic process Platelet Phase .. Coagulation Phase.. Clot Reaction.. Fibrinolysis
What is Primary Hemostasis -Process of forming a platelet plug at the sit of vessel injury -Consists of a vasoconstriction of platelet adhesion
Define Vasoconstriction(Vascular Phase) "tightening" of blood vessels to divert blood flow around the damaged vessel -enhances contact activation of platelets and coagulation factors
Define Platelet Adhesion( Platelet Phase) Platelets become activated and aggregate at the site of injury, forming a temporary loose, platelet plug
What happens in Secondary Hemostasis Stabilizes the initially loose platelet plug, a sequence of enzymatic reaction is initiated which culminates in fibrin strands forming at the platelet plug
What happens in the "Coagulation Phase" -Coagulation factors interact with each other to form a fibrin clot (reinforces the platelet plug...ADP, thromboxon, PFB) "FIBRIN FORMING SYSTEM
What are "Coagulation Factors" Proteins normally presented in the blood (most are produced by the liver) ...normally "turned off" (inactive)..."A" signals the factor in its "active" form of coagulation cascade
What happens in the "Extrinsic Pathway" Activated when endothelial cells are injured and tissue factor is released -activated factor VII and tissue factor bind to form a complex.(this complex, plus calcium, activates factor XTissue Factor)
What happens in the "Intrinsic Pathway" Initiation occurs when factor XII is exposed to a negatively charged surface(termed the contact phase) "REQUIRES CLOTTING FACTORS VIII-XII
What is the "COMMON PATHWAY" When factor Xa bigs to the platelet surface, a complex is formed composed of platelet phospholipid, calcium and factor Va...-Complex converts prothrombin to thrombin which in turn converts fibrinogen to fibrin
Explain Fibrinolysis Bodys ways of keeping coagulation from becoming excessive and occluding the blood vessels
Thromboplastin activates what factor? FACTOR 7
define the REGULATION STAGE Balance between coagulation and fibrinolyctic process must be maintained otherwise excess clotting or fibrinolysis will occur
Thrombophilia causes what D.V.T. (Deep Venouse Thrombosis) or P.E. (Pulmonary Embolism)
define THROMBOPHILIA Hypercoagulable state due to inherited(heriditary/genetic) defects or acquired defects in one or several factors of the coagulation cascade
FACTOR 1(fibrinogen) ...define .AFIBRINOGENEMIA Total absense of measurable fibrinogen (RARE CONGENITAL DISORDER)
FACTOR 1(fibrinogen)...define HYPOFIRINOGENEMIA Below normal levels of fibrinogen -treated by cryoprecipitate or FFP
FACTOR 1(fibrinogen)...define DYSFIBRINOGENEMIA altered structure of the fibrinogen molecule -usually asymptomatic but has been associated with both bleeding and thrombotic events
explain ...FACTOR V (proaccelerin)GENE DEFECT (MOST COMMON CAUSE OF THROMBOPHILIA) coafactor in coagulation cascade..defieceny causes bleeding but factor V mutation causes thrombotic events due to impaired degradation of factor V resulting in continued thrombin generation
what does MTHFR do ? Breaks down homo cysteine
deficiency of MTHFR causes ? increase of homocysteine leading to thrombosis
Acquired Homo cysteine is due to deficiency of vitamin B6 and B12
What happens if Prothrombin does not break down keeps on activating thrombin to convert fibrinogen into a fibrin clot
deficiency in vWF causes (FACTOR VIII) vonWillebrand's Disease
Defect or absense of coagulant portion causes Classic Hemophilia A
Acute Phase Reactant Increase in inflammation, stress, pregnancy and infectin which can lead to clot formation
What is the purpose of Quality Assurance Gathering/evaluating information and data about services/tests provided
What is the purpose of P.I. Implement an interdisciplinary approach to collection, analysis and reporting of performance measures
What is the overall goal of P.I. Effect quality improvement including accuracy and precision
Where does P.I. begin in a hospital setting Begins in the lab before specimen is collected
What are Logbooks Logs examined in quality assurance meeting to determine problem areas (also document problem areas with incident reports)
Define INCIDENT REPORTS a formal written description of an incident/unusual occurrence
What is the purpose of incident reports To objectively document exactly what happened (GOAL is to prevent another episode)
Define DELTA TEST comparison between current results of the lab test and previous test results for same patient (CLS)
What are FLOOR BOOKS Containcs information that lists the name of each test/procedure (useful to aid in consistency of testing for quality control purposes "AKA PROCEDURE, REFERENCE or TEST MANUAL)
what does JCAHO stand for Joint commission on accrediation of healthcare organization (PRIVATE NON-GOVERNMENT AGENCY)
What does JCAHO do Establishes guidelines for healthcare agencies regarding quality of care
What is CQI Continuous Quality Improvement
What does CQI do ? Framework and management commitment to improve healthcare structure, processes, outcomes, and customer satisfaction
What is the ultimate goal for CQI IMPROVE PATIENT OUTCOMES
what are the "Poor patient outcomes (5 D's)" -DEATH -DISEASE -DISABILITY -DISCOMFORT -DISSATISFACTION
Define P.D.C.A. Plan-Do-Check-Act
What is the purpose of PDCA Cycle for assessing, making changes, then reassessing and putting in action
What is the primary goal during a specimen collection obtain accurate samples for analysis
Occupational Safety and Health Administration (OSHA) was established when ? 1970 by US Congress
What is the goal of OSHA Assures every working person in the nation a safe and healthful working condition
Center of Disease Control establishes ? Universal Precautions (OSHA enforces them)
What are Bloodborne Pathogens Microorganisms that cause disease in humans and are transmitted only through contact with infectious body fluids (NOT urine or feces..unless blood is visible) examples:HIV/AID, malaria, syphilis, ebola virus
What is the main symptom for Hepatitis B Jaundice (other symptoms may be ..fatigue abdominal pain, anorexia, nausea and vomiting)
How many vaccines are required for Hep. B? 3 shots over 6month period
What disease is the leading cause for liver transplants Hepatitis C
What are the symptoms for Hepatitis C Fatigue and Abdominal Pain
What are some symptoms for Human Immunodeficiency Virus Swollen lymph nodes, weight loss, night sweats, opportunist infections, skin lesions (can eventually lead to AIDS)
Define Prophylaxis The prevention of disease
Highest number of phlebotomy injuries occur with ? Butterflies
What does the bacteriology dept. do deals with identification, study, and cultivation of bacteria and their application in medicine, agriculture, industry, and biotechnology
What is Mycology The study of FUNGI (fungi break down dead organic material and continue the cycle of nutrients through ecosystems)
What is Virology The study of biological viruses
What is Serology The study antigens and antibodies in serum (red top tubes, may base use as well for the detection of an antigen-antibody reaction)
What is Immunology The study of immune process and immunity (immunology lab IDs antibodies that are produced due to a disease state)
What is the purpose of the infection control system Meant to break chain of infection
define asepsis destruction of organisms after they leave the body (hand washing, disposable equipment, gloves)
What does fire need in order to start Needs Oxygen, heat, and fuel
What are the four categories of fires Class A,B,C,D
What is Class A based on the "category of fires" Paper, wood, cloth and plastics
What is Class B based on the "category of fires" Flammable solvents such as gases, oils, paints, and grease and an interaction with air and vapors
What is Class C based on the "category of fires" In or near electrical equipment
What is Class D based on the "category of fires" Combustible metals such as lithium and magnesium
What is the use of Class A FIRE EXTINGUISHERS For ordinary combustible fires (contains soda and H2o)
What is the use of Class B FIRE EXTINGUISHERS For fires from solvents and air-vapor mixtures (contains foam, dry chemical, or CO2)
What is the use of Class C FIRE EXTINGUISHERS Used for electrical fires (contains dry chemicals)
What is the use of "Halon" FIRE EXTINGUISHERS For computer fires
What does R.A.C.E. stand for Remove the patient, activate the alarm and alert other staff, contain or confine the fire by closing all doors, extinguish the fire if its safe to do so
What does P.A.S.S. stand for PULL the pin, AIM the nozzle just above the base of the fire, SQUEEZE the trigger of the extinguisher, SWEEP the nozzle over the fire
Any chemical that comes into contact with the skin or eyes must be treated STAT
What is the use for Material Safety Dada Sheets (MSDS) Detailed information about identity of chemical, physical characteristics, physical hazards and how to handle them, reactivity and dangerous reactions, health hazards, handling precautions and control measure (MUST BE KEPT IN A PROMINENT PLACE)
What does CHP stand for Chemical Hygiene Plan
What are the four types of biological hazards and waste Solid, Chemical, Radioactive, Infectious
Alcohol can become what type of hazard flammable, poisonous
Cytotoxic drugs can be what type of hazard Carcinogenic
Nitrous Oxide can be what type of hazard Oxidizer and irritant
Formalin can be what type of hazard Carcinogenic irritant
Bleach can be what type of hazard Skin irritant, can compromise the respiratory tract
Betadine is what type of hazard Thyroid/renal disturbance
Mercury can be what type of hazard poisonous, corrosive
Glutaraldehyde can be what type of hazard Skin irritant, can be harmful to asthma patients (can cause deterioration of latex gloves)
White out can be become what type of hazard Flammable, and can lead to tumors
What blood levels are HIGH in the morning ? Hormones: testosterone, cortisol, adrenocorticotropic hormone (ACTH, iron and insulin
What blood levels are LOW in the morning Eosinophil count, creatine, glucose, triglycerides
What are some specimens that have to be kept cold during transport Blood gases, gastrin, amoonia, lactic acid, renin
What color will plasma or serum be if there is a leakage of hemoglobin Pink or red
Rupture of RBC membrane causes a leakage of hemoglobin which imparts a pink or red color to the serum/plasma and may affect values of certain tests like? CBC..LD..AST..K+..Fe..T4
Additive-containing tubes must be inverted gently how many times ? 8-10times
What is the Analytic phase Takes place during testing the specimen
What is post analytic phase reporting results and follow up
What are the most common fasting specimens Triglycerides, cholesterol, and glucose
what is the purpost of Two-Hour Postprandial Glucose Test Screens for Diabetes
What is the purpose of a Glucose Tolerance Test Diagnoses diabetes mellitus and hypoglycemia (similar to epinephrine tolerance test but glucagon is INJECTED INSTEAD)
What is the purpose of a Lactose Tolerance Test Diagnoses lactose intolerance
what is the purpose of epinephrine tolerance test determines the amount of GLYCOGEN stored in the liver (epinephrine helps break down glycogen stores and are used for energy when needed)
What is the purpose of Therapeutic Drug Monitoring (TDM) Measures amount of specific medication in a patient's system
Why are blood cultures performed Aids in the diagnosis of SEPTICEMIA
When is it best to draw a blood culture When FEVER SPIKES
What is the purpose of a Bleeding time Test Assesses status of patient's hemostasis (detects platelet function disorders "PART OF STANDARD PRE-SURGICAL WORK UP"
Blood smears can be performed using what type of blood? Capillary blood or blood from lavendar tube within 1hr or being drawn into tube (part of CBC)
What is Neonatal Screening? ... a state that requires infants to be tested for phenylketonuria (PKU) and congenital hypothyroidism (should be tested 24-72 hours after birth)
What is the purpose of ABG Monitors patients respiration status (obtaines for measuring Po2, PCO2, and pH of blood..which tells the degree of oxygenation and acid base balance of blood.
What are the most common specimens collected in legal cases ETOH, Drug screening, DNA analysis
POINT OF CARE TESTING is performed where at patients bed side (falls under CLIA)
What is the most common test done for POINT OF CARE TESTING Glucose level, PT, aPTT/PTT,cardiac enzymes (reduces TAT)
What are the common tests for common pathologies Troponin, Amylase, lipase, ABG, BUN, Creatinine , Hct, Hgb, RBC Count
What is the duty of College of American Pathologist (CAP) Sets standards for phlebotomy ...profeciency testing lab testing by pathologist and CLSs REGULATION OF CLINICAL LABORATORIES
What is the duty of CLSI Establishes procedural guidelines for all areas of the lab
What is the duty of JCAHO Accredits agency for hospitals and nursing homes ..inspects every 2 years ..enforces standards established by CLSI with CAP to provide lab accreditation
What is the purpose of CLIA Ensure quality lab testing
What is the duty of Survey and certification group(SCG) has responsibiliyu of implementing CLIA program
Created by: moralesm05
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