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Preanalytical Phase of Testing
Begins when test are ordered, ends when testing begins.
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Reference Ranges/Intervals
- •Tests confirm health or screen, diagnose, & monitor disease
- •Test results are compared with specimens of healthy people
- •Consist of range of values with high & low limits
- •Most often based on healthy, fasting people
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Basal State
Definition: resting state of body early in morning after fasting 12 hours
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Basal-state specimen
- –Ideal for establishing reference ranges on inpatients
- –Effects of diet, exercise, etc. on test result are minimized
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Basal state is influenced by
- –Age
- –Gender
- –Conditions of body
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Physiological variable -age
RBC, WBC, creatinine clearance
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Physiological variable -dehydration
Hemoconcentration, RBC, enzymes, Fe, Ca, Na
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Diurnal variation
TSH, cortisol, Fe
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Exercise/IM injection
pH, PCO2, CK, LDH, glucose
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Temperature and humidity
Hemoconcentration
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problems sites Burns, Scars, & Tattoos
- –Veins are difficult to palpate here
- –May have impaired circulation
- –New burns are painful
- –Tattoos may be more susceptible to infection; dyes may interfere
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Damaged Veins
- –Sclerosed: hardened
- –Thrombosed: clotted
- –Difficult to puncture & yield erroneous results
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problem site edema
- –Swelling caused by abnormal accumulation of fluid in tissues
- –Results when fluid from IV infiltrates surrounding tissues
- –Contaminates blood with tissue fluid
- –Veins are harder to locate, & tissue is fragile
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Problem sites hematoma
- –A swelling or mass of blood
- –Caused by blood leaking from vessel during venipuncture
- –Can be painful, contaminate blood sample, obstruct blood flow
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Arterial Line
- –A catheter placed in an artery (usually radial)
- –Provides accurate & continuous measurement of blood pressure
- –No tourniquet or venipuncture on an arm with an arterial line
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Arteriovenous Shunt or Fistula
- –The permanent, surgical fusion of an artery & a vein
- –Created to provide access for dialysis
- –Located on back of arm above wrist
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Heparin or Saline Lock
- –A catheter or cannula connected to a stopcock/cap w. diaphragm
- –Provides access for administering medicine or drawing blood
- –Placed in vein in lower arm above wrist for up to 48 hrs
- –Flushed w. heparin or saline to prevent clogging
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Intravenous (IV) Sites
- –IV line: a catheter inserted in a vein to administer fluids
- –Avoid collecting blood from arm w. IV
- –Blood may be contaminated w. IV fluid
- –If necessary, collect below IV
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Central Vascular Access Devices (CVADs)
- –Known as indwelling lines
- –Consist of tubing inserted into a main vein or artery
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Central Vascular Access Devices (CVADs)
- –Used for:
- •Administering fluids & medications
- •Monitoring pressures
- •Drawing blood
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Types of CVADs
- –Central venous catheter or line
- •Inserted into large vein (subclavian)
- •Advanced into superior vena cava
- –Implanted port
- •A small chamber attached to indwelling line
- •Surgically implanted under skin (upper chest or arm)
- –Peripherally inserted central catheter
- •Inserted in veins of extremities & threaded into central veins
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Excessive Bleeding
- –Patients on aspirin or anticoagulant may bleed longer
- –Maintain pressure until bleeding stops
- –If bleeding continues >5 min, notify appropriate personnel
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Fainting
- –A loss of consciousness & postural tone
- –Caused by insufficient blood flow to brain
- –Have patients w. history of fainting lie down during venipuncture
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Nausea and Vomiting
- –Discontinue blood draw until feeling subsides
- –Give patient emesis basin or wastebasket
- –Apply cold, damp washcloth to forehead
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Pain
- –Warn patient before needle insertion
- –Avoid excessive, deep, blind, or lateral redirection of needle
- –Extreme pain or numbness indicates nerve involvement; remove needle immediately, apply ice, document incident if pain persists
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Seizures/Convulsion
- –Discontinue draw immediately
- –Hold pressure over site without restricting patient’s movement
- –Do not put anything in patient’s mouth
- –Protect patient from self-injury
- –Notify first-aid personnel
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•Nerve Injury
–Caused by:
- •Improper site or vein selection
- •Inserting needle too deeply or quickly
- •Excessive lateral redirection of needle
- •Blind probing
- –If initial vein entry is unsuccessful:
- •Use slight forward or backward redirection of needle
- •Remove needle & try an alternate site
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Hemoconcentration
- –A decrease in fluid content of blood
- –An increase in nonfilterable large molecules
- –Caused by stagnation of normal venous flow due to tourniquet
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Hemolysis
- –Damage to or destruction of RBCs
- –Hemoglobin escapes into fluid part of specimen
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Partially Filled Tubes
- •(short draw)
- –Blood-to-additive ratio may be incorrect
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Specimen Contamination
- –Allowing alcohol residue, fingerprints, glove powder, baby powder, urine on newborn screening samples
- –Getting glove powder on blood films or capillary specimens
- –Dripping perspiration into capillary specimens
- –Following improper antiseptic procedure
- –Using wrong antiseptic
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Persistant vomiting and diarrhea can cause
hemocentration
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Outpatient specimens are they basal state
No.
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Lipemic means
High levels of lipids cause the serum to appear milky
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circadian
means having a 24 hour cycle
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many drugs toxic to liver which enzymes are affected
AST, ALP, SCOT (GGT, LD
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CRUD stands for
Compounds reacting unexpectedly as the desired
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drugs that interfere with blood shold be stopped
4-24 hours
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drugs that interefere with urine should be stopped
48-72 hours.
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Fever affects levels of
hormone.
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Jaundice is also called
icterus
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Biliribin
is breakdown of RBC
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Icerteric means
specimens urine, plasma and serum have deep yellow color due to the deposits
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Blood to the point of life-loss
exsanguination
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Define iatrogenic
Adjective used to described adverse condition brought on by the affects of treatment.
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Light blue top
buffered sodium citrate
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Word Roots
- •Foundation on which term is built
- •Typically indicates tissue, organ, body system, color, condition, substance, or structure
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Word root TO CLOT
Thrombo
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Prefixes
- •A word element that comes before a word root
- •Modifies meaning of word root by adding information, such as presence, absence, location, number, or size
aspesis
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Suffixes
- •A word ending
- •Follows a word root & changes or adds to its meaning
- •To determine meaning of a medical term, first identify the meaning of the suffix.
Gastro -word root ic gastric
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Infection:
–When a microorganism invades body, multiplies, & causes injury or disease bacteria, protozoa, fungi, viruses
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Pathogen:
a microbe capable of causing disease
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Types of Infection Communicable
- •Able to be spread from person to person
- •CDC investigates & controls communicable diseases & epidemics
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–Nosocomial & healthcare-associated infections (HAIs)
- Infections acquired in hospitals & other healthcare settings
- •1.7 million HAIs & 99,000 associated deaths occur each year
- •Caused by infected personnel, patients, visitors, food, drugs, or equipment
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Chain of Infection
Causative agent, reservior, exit pathway, means of tansmission, entry pathoway and suspectable host.
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What are some means of transmission
- –Airborne
- –Contact
- –Direct (touching, kissing)
- –Indirect (contaminated objects)
- –Droplet (coughing, sneezing)
- –Vector (insect, arthropod, animal)Vehicle (food, water, drugs
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What is viability
ability of the microbe to survive on an object
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what is virulence
degree to which capable of causing disease
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NIOSH requires upon entering a room of patient who has airbone disease.
national institute of occupational safety and health respirator n95
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OSHA requires which vaccine to be provided free
HBV
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What is some PPE
- •Gloves
- •Gowns
- •Lab coats
- •Masks, face shields, & goggles
- •Respirators
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Isolation Procedures
–Protective/reverse isolation
For patients highly susceptible to infections
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Universal precautions (UP) CDC what year started
Blood & body fluids of all people are potentially infectious, 1985
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Airbone precautions
negative air pressure with cycles 8-12/hr
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Biohazard Exposure Routes
- –Airborne
- –Ingestion
- –Nonintact skin
- –Percutaneous (through the skin)
- –Permucosal (through mucous membranes)
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Hepatitis B virus (HBV) & hepatitis D virus
- •Present in blood & other body fluids
- •Can survive up to a week on objects
- •Transmitted via needlesticks, sexual contact
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Hepatitis C virus (HCV)
•HCV exposure hazards
- •Present in blood & serum; sometimes saliva
- •Infection primarily occurs after large or multiple exposures
- •Transmitted via needlesticks, sexual contact
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•Exposure Control Plan
–
- –Must be written
- –Must be reviewed & updated at least annuallyNonmanagerial
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Surface Decontamination (required by OSHA)
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•Components Needed for Fire to Occur
- –Fuel: combustible material
- –Heat: raises temperature of material until ignition
- –Oxygen: to maintain combustion
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Fire symbol is a
tetrhedron
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•Classes of Fire
–Class A
–Class B
–Class C
•Electrical equipment
•Require nonconducting agents to extinguish
- •Ordinary combustible materials (wood, paper)
- •Require water/water-based solutions to extinguish
- –Class B
- •Flammable liquids & vapors (paint, oil, grease, gasoline)
- •Require blocking oxygen or smothering to extinguish
- –Class C
- •Electrical equipment
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