MA 201 Clinical Duties

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MA 201 Clinical Duties
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  1. Function of Immune System
    • 1. To protect body against invaders
    • 2. Recognize things as SELF or Non-SELF
    • 3. Attempts to destroy non-self things (protection)
  2. Name some Antigens
    • 1. bacteria
    • 2. viruses
    • 3. fungi
    • 4. parasites
    • 5. foreign matter
  3. List 5 types Foreign Matter
    • 1. Cell
    • 2. Tissue
    • 3. Protein
    • 4. Food
    • 5. Air Particles
  4. List some Non-Self bodies
    • 1. antigens
    • 2. blood or tisue from transplant
    • 3. foreign material
    • 4. food we eat
    • 5. particles in the air
    • 6. allergens
  5. Name 3 Immune system Lines of Defense
    • BARRIERS
    • 1. Anatomical barriers
    • -skin / mucose membranes
    • 2. Biological barriers
    • -sweat / oil on skin
    • 3. Mechanical barriers
    • -dead skin sloughs off
    • -vomiting
    • -coughing

    • INFLAMMATION
    • When exterior barriers broken
    • -injury or invasion
    • Results in warm, red, swollen skin

    • ANTIBODY DEFENSE
    • specific cells that attack antigen
  6. Name 3 Immune Functions
    • 1. Identify self non-self
    • 2. Maintain Homeostasis
    • 3. Continual surveillance
  7. Name 3 types of cells in blood stream
    • 1. Red blood cells (RBC) Erythrocytes - carry O2 to the cells
    • 2. Platelets Thrombocytes - clot blood
    • 3. White blood cells (WBC) Leucocytes - fight disease as part of the immune system
  8. Name 2 types of White Blood Cells (WBC)
    • Granulated
    • -Eosinophils
    • -Neutrophils
    • -Basophils

    • Non-Granulated (most common)
    • -Lymphocytes
    • -Monocytes
  9. Monocytes (WBC) Non-granulated
    Immature cells grow/develope into large cells

    Macrophages - help fight infection through phagocytosis (engulf and destroy)
  10. Lymphocytes (WBC) Non-granulated
    Recognize specific antigen target

    • 2 Types
    • 1. T-Lymphocytes mature in Thymus gland (T for T)
    • 2. B-Lymphocytes mature in bone marrow (B for B)
  11. Thymus
    • Located in anterior portion of chest
    • Dissapears over time by late ages
    • Older people get sick easier without it.
  12. List 8 Organs of Immune System
    • 1. Bone marrow
    • -fight invaders that reach circulatory system
    • 2. Thymus Gland
    • -where t-lymph mature
    • 3. Lymph Nodes
    • -filters antigens for destruction
    • 4. Spleen
    • -fight invaders that reach circulatory system
    • -carries tons of red blood cells (RBC)
    • -if gone, will get sick easier
    • 5. Tonsils
    • -fight invaders of the respiratory system
    • 6. Adenoids
    • -fight invaders of the respiratory system
    • 7. Appendix
    • -fight invaders of the digestive system (vestigal organ / not needed)
    • 8. Peyer's Patches
    • -in intestinal track (the ilium)
    • -fight invaders of the digestive track
    • -where they grow
  13. Cell Markers
    How immune cells determine if encountered cells if self non-self
  14. Major Histocompatibility Complex (MHC)
    This is the self marker for all cells
  15. Foreign Cells
    Any cell without the MHC marker

    Will be destroyed by immune system
  16. T-Lymphocytes
    • Most abundant of all WBC.
    • Acts directly on invading cells.
  17. List 4 types of T-Lymphocytes
    • 1. Helper T-cells
    • - helps other cells perform functions
    • - act as security and detecs invaders
    • - have a CD4+ marker (checked during HIV infection)

    • 2. Suppressor T-cells
    • - keep virus at bay (no flare-ups)

    • 3. Killer T-cells
    • - directly kill non-self cells
    • - aka Cytotoxic T-cells

    • 4. Memory T-cells
    • - injury (will remember what did last time and act faster)
    • - muscle memory from repitition
  18. B-Lymphocytes
    • Produce antibodies
    • - cell markers that fit specific antigen and make useless. (Virus)
    • - known as
    • - Humoral Response (B-Cell) or
    • - Antibody-mediated (T-Cell) response
  19. Extra Information
    • 1. CBC most common blood draw
    • 2. Elevated WBC count = internal infection
    • 3. Sarc=flesh
    • 4. Oma=tumor/mass
    • 5. Hep C most deadly, no cure
    • 6. Erytheme "means red"
  20. Inflammation
    • - cells release histamine
    • - dialates blood vessels
    • - slows blood flow, allows vessel walls to be more permiable
    • - results in warm, redness, and swelling
  21. Immunization
    • - deliberate introduction of specific antibody
    • - allows cells in body to learn to kill that type of cell
    • - may need boosters later on (tetnis)
  22. Active Immunity
    Makes own immunity with a vaccines
  23. Passive Immunity
    Another source injected to counter imediate attack (Tetanus)
  24. Acquired Immunodeficiency Syndrome (AIDS)
    Caused by Human Immunodeficiency Virus (HIV)
  25. Fluid that AIDS survives in best.
    • 1. Blood (WBC)
    • 2. Semen
    • 3. Vaginal Secretions
  26. HIV (Retrovirus)
    • 1. Contains RNA vs DNA
    • 2. RNA changes DNA to RNA (no changing back)
    • 3. Once RNA outnumbers T-cells, body can no longer protect itself
  27. Immunosuppressed
    • 1. No longer able to protect self with T-cells
    • 2. Can get an "opportunistic infection"
  28. Ways to get HIV (4)
    • 1. Unprotected sex
    • 2. Sharring needles
    • 3. Mother to fetus / infant
    • 4. Blood products
  29. Early Signs of HIV
    • Headache
    • Fever
    • Fatigue
    • Enlarged Lymph Nodes
  30. Signs and Symtoms (HIV)
    • weight loss
    • yeast infection
    • memory loss
    • rashes
  31. Difficulty Swallowing (infection)
    • Lymph nodes reacting to internal infection.
    • If lasts too long, have checked out.
  32. Opportunistic Infection
    • Pneumocystis pneumonia (fungal in lungs)
    • Kaposi's Sarcoma
  33. HIV Tests
    • 1. ELISA (enzyme-linked immunosorbent assay)
    • - most common / least expensive
    • - can give false positive

    • 2. Western Blot
    • - used to confirm HIV diagnosis
  34. AIDS Test
    1. Requires positive HIV test and one of the following:

    • - CD4+ count less than 200
    • - Opportunistic infection
    • - AIDS related cancer, severe wasting, dementia
  35. Allergies
    Secomdary response to normally harmless substance
  36. Histamines (allergies)
    Cause mucose membranes to secrete and capillaries to become permiable
  37. Cancer
    A group of diseases characterized by uncontrolled growth or abnormal cells
  38. Neoplasm (cancer)
    New growth forming tumor
  39. Metastasis (cancer)
    Cells break away from tumor and spread
  40. Benign (cancer)
    Slow growing, doesn't invade other tissue
  41. Malignant
    Fast growing, invades surrounding tissues
  42. Cancer Classifications (3)
    • 1. Carcinomas - from epithelial tissue
    • 2. Sarcomas - from connective tisues
    • 3. Lymphomas - from blood and blood forming organs
  43. Cancer Staging (3)
    • 1. T - size and extent of spread of primary tumor
    • 2. N - presence of regional lymph node metastasis (local or moving)
    • 3. M - presence or absence of distant metastasis (where local or distant)
  44. List 6 Characteristics of Cancer
    • 1. Altered cell structure
    • 2. Lack normal growth controlling mechanics
    • 3. Will grow and invade other tissues
    • 4. Lack contact inhabitions - keep growing
    • 5. Do not respond to growth factors
    • 6. Are invasive, causing distruction of normal tissue
  45. List 4 Catagories of Cancer
    • 1. Chemical
    • 2. Viral
    • 3. Physical
    • 4. Familial
  46. Seven warning signals of Cancer

    CAUTION
    • 1. Change in bowel / bladder habits
    • 2. A sore not healing
    • 3. Unusual bleeding / discharge
    • 4. Thickening / lump anywhere
    • 5. Indigestion / difficulty swallowing
    • 6. Obvious change in wart / mole
    • 7. Nagging cough / hoarseness
  47. Diagnostic Tests (Cancer)
    • 1. Biopsy
    • 2. Tumor Markers
    • 3. Genetic Testing
    • 4. Tumor Imaging
  48. Biopsy (cancer)
    Removal of sample, microscopic exam
  49. Tumor Markers (cancer)
    • Blood test to detect proteins
    • CA125 - Ovarian Cancer (W)
    • PSA - Prostate Cancer (M)
  50. Genetic Testing (cancer)
    Blood test sampling to detect genes of cancer from family history on both sides
  51. Tumor Imaging (cancer)
    • Radiological / imaging test to detect
    • Pep Scan - Thermal image for hot spots that mean cancer, quite accurate
  52. Cancer Therapy Goals
    • 1. Cure
    • 2. Control
    • 3. Palliation - control symptoms (no cure)
  53. Brachytherapy
    Radioactive material placed at tumor
  54. Cancer Treatment
    • 1. Radiation
    • 2. Chemotherapy
    • 3. Surgery
  55. Cancer Treatment (Radiation)
    Use of radiation to damage DNA of the cancer cell

    Brachytherapy use of local radiation therapy
  56. Cancer Treatment (Chemotherapy)
    Use of trong chemicals / medications to change cell division of cancer cells

    Systemic treatment, kills all fast dividing cells (including hair, skin, nails)
  57. Cancer Treatment (Surgery)
    Surgical removal of malignant tissue
  58. Cancer Vaccine
    Effects depend on response of healthy immune system
  59. Chronic Fatigue Syndrome
    Group of symptoms thought to be caused by Epstien-Barr Virus
  60. Lupus Erythematosus
    • Cronic disease causing inflammation of body parts
    • Body attacks itself
    • Treat by rest when needed, limit activity and sun exposure
  61. Signs of Lupus
    • Extremeties are always purple at the tips during cold weather
    • Butterfly rash on face
  62. Rheumatoid Arthritis
    • Ulnar deviation (toward ulnar side / pinky)
    • Swan neck of fingers
  63. Lymphedema
    - Swelling in tissues caused by acumulation of lymphatic fluid

    - Treated with elevation, gentle pressure massage, and or wrapping with bandages
  64. Diseases to Know
    • 1. Anthrax - Bacillus Anthracis
    • 2. Botulism - Clostridium Botulinum
    • 3. Yetanus - Clostridium Tetani
    • 4. Pneumonia - Streptococcus Pneumoniae
    • 5. Whooping Cough - Bordetella Pertussis
    • 6. Urinary Infection - Escherichia coli
    • 7. Gonorrhea - Neisseria Gonorrhoeae
    • 8. Food Poisoning - Salmonella
    • 9. Typhoid Fever - Salmonella Typhi
    • 10. Syphilis - Treponema Pallidum
    • 11. Plague - Yersinia Pestis
    • 12. Chickenpox - Vericella Zoster
  65. Syphilis Test
    • 1. Blood test cheap and easy
    • 2. Not accurate in first 4-6 weeks of infection
    • 3. 25% will be false negative

    4. Completely accurate in second phase
  66. Prevent Hep A
    • Avoid direct contact
    • Avoid fecal contaminated food / water
  67. List info documented when accident in facility
    • 1. Date
    • 2. Time
    • 3. What Happened
    • 4. Staff members involved
    • 5. Witnessed
    • 6. Injuries
    • 7. Action taken
  68. Ideal medical office temp
    72 degrees
  69. OSHA
    • Occupational Safety and Health Administration
    • Can close lab
  70. CLIA
    • Clinical Laboratory Improvement Amendments
    • Sets standards for lab testing
  71. CDC
    Center for Disease Control
  72. Infection Control
    • Method used to control spread of disease
    • Protect patient and self
  73. Standard blood / body fluid PRECAUTIONS
    • 1. wash hands
    • 2. use PPE
    • 3. dispose sharps immediately
    • 4. properly dispose medical waste
  74. Medical Waste (red bag)
    Any bodily fluid from any source
  75. Medical Waste (sharps container)
    • glass
    • needles
    • slides
    • blades
  76. Standard Universal Precautions
    Assume all is contaminated
  77. Disease Transmition
    • 1. need a germ
    • 2. need a host (carrier)
    • 3. transmission (vector)
    • 4. way into body (cut, mucosa, etc...)
  78. Infection Cycle (break one)
    • 1. infectious agent
    • 2. reservoir
    • 3. portal of exit
    • 4. mode of transmission
    • 5. portal of entry (feet, mouth, nose, etc)
    • 6. susceptible host
  79. Infection Cycle
    Protective Mechanism
    • 1. Skin
    • 2. Mucos Membranes
    • 3. Mechanical (cough, sneeze, tears)
    • 4. pH (sweat, urine, stomach, secretions)
  80. Microorganisms
    Disease causing agents (Pathogens)
  81. Microorganisms (list 5)
    • 1. Bacteria
    • 2. Viruses
    • 3. Protozoa
    • 4. Fungi
    • 5. Parasites
  82. Growth requirements for microorganisms
    • 1. Normal body temp
    • 2. Darkness
    • 3. Moisture
    • 4. Low pH
  83. Bacteria (microorganism)
    • Aerobic - survives in O2
    • Anaerobic - can't survive in O2
  84. Viruses (microorganism)
    Smallest of pathogens
  85. Protazoa (microorganism)
    Single-celled, attach to other organisms
  86. Fungi (microorganism)
    Simple plants, depend on other life forms for nutrition
  87. Parasites (microorganism)
    Type of organism that depends on other organism for nutrition
  88. Bacteria (shape)
    • Cocci - round
    • Baccili - rod
    • Spirochete - spiral
  89. Bacteria (grouping)
    • Diplo - pairs
    • Strepto - chains
    • Staphylo - groups
  90. Bacteria (Gram Stain)
    Stain to stick
    • - Possitive - purple / violet
    • - Negative - pink / red
  91. Gram Stain Test Order
    • 1. Crystal Violet
    • 2. Gram's Iodine
    • 3. Rinse with Acetone
    • 4. Safranin
  92. Bacteria (Spore Forming)
    Capsule like covering to protect self
  93. Anticeptics
    Most common used to clean skin for injection / surgery
  94. Cleaning Methods
    • 1. Sanitation
    • 2. Disinfection
    • 3. Sterilization
  95. Sanitation (cleaning method)
    • Process of washing and scrubbing to remove material
    • - hand washing
  96. Disinfection (cleaning method)
    • Process to remove disease producing microorganisms (pathogens)
    • Used on instruments with chemicals
  97. Sterilization (cleaning method)
    • Process of destroying all forms of living organisms (including spores)
    • Steam autoclave (good for 30 days)
  98. Before Gloves
    • Wash hands with soap and water
    • Inspect for holes, rips, tares
  99. Asepsis
    State of being free of all pathagenic microorganisms
  100. Medical Asepsis (aseptic technique)
    Method used to keep areas free of pathogens
  101. Surgical Asepsis (aseptic technique)
    Way to protect patient from infection (sterile)
  102. Autoclave
    • Uses steam and pressure
    • 15 psi
    • 250 degrees for 15-20 minutes
    • Must sanitize first
    • Good for 30 days
  103. Starilization Indicator (autoclave)
    • 1. Muslin wraps secured with indicator tape
    • 2. Masking tape that changes color (stripes) when run through autoclave
    • 3. Place paper indicator inside with instruments and outside first wrap.
  104. Instrument Guidelines
    • Do not allow body fluids to dry on intruments
    • Soak immediately in detergeant solution
    • - use solution of neutral pH to prevent corrosion
    • - should contain special protein to break down body fluids
    • Scrub all surfaces with brush to remove material
  105. Instrument Grouping Guidelines
    • Separate delicate from heavy ones
    • Sharp ones from others
  106. Instrument Inspection
    Check for:

    • Nicks
    • Dullness
    • Warping
  107. Instrument Classifications (3)
    • 1. Cutting
    • 2. Clamping / Grasping
    • 3. Dilating / Probing
  108. Tissue Forceps
    For grasping - for control during dissection / suturing
  109. Dressing Forceps
    Pick up dressing and delicate tissue
  110. Cleaning Instruments
    • 1. Soak in detergent with proteins to break down body fluids (zephrin chloride)
    • 2. Scrub with brush
    • 3. Dry
    • 4. Hinges / handles open - sterilize in autoclave
  111. Parts of Instruments (5)
    • 1. Ring Handles - thumb and finger like scissors
    • 2. Thumb Handles - like tweezers
    • 3. Ratchets - back by handle, allows holding
    • 4. Serrations - fissure engraved for grabbing / holding when clamping
    • 5. Teeth - sharp, hold tissue
  112. Clamping
    Also called grasping intrument
  113. Dilating / Probing
    • Hold cavities / wounds open
    • Used to explore wounds
  114. Syringes
    • Named by size
    • CC = cubic centimeter
    • ML = milliliter

    1cc = 1ml
  115. Needles
    • Named by length and Lumen (gauge)
    • Gauge - bigger the number, smaller the lumen
    • 16g is larger than 28g
  116. Needle Parts
    • Hub - back
    • Shaft
    • Bevel
    • Point
  117. Common Scissors
    • Bandage
    • Utility
    • Suture (hook for under suture)
  118. Day before Minor Surgery
    • Confirm appointment
    • Get all necessary surgical intruments
  119. Patient Prep
    • Obtain consent form
    • Answer any questions
    • Vital signs
    • Verify known allergies
    • Empty bladder
  120. Skin Prep
    • 1. Wash and glove hands
    • 2. Gauze squares in soap solution
    • 3. One gauze at a time, soap area to be shaved
    • 4. Use scissors to cut long hair first
    • 5. Shave area with razor at 30 degrees
    • 6. Shave in direction of hair
    • 7. Apply antiseptic solution to site with transfer forceps
    • 8. Begin in center and work out in circular pattern
    • 9. Cover with sterile drape
  121. Patients Record
    • 1. Description of procedure
    • 2. Date and time
    • 3. Signed consent form
    • 4. Vital signs
    • 5. Any complications
    • 6. Meds ordered
    • 7. Findings
    • 8. Instructions for home care
    • 9. Number of sutures
    • 10. Where sutures located
    • 11. How long stay in
  122. Mayo Stand Height
    Waist level
  123. Anesthesia
    • General - unconscious
    • Local - localized to area, loss of feeling
  124. Suture Material (Absorbable)
    • Made from organic material
    • Will be absorbed by body
    • Used deep in body
  125. Suture Material (Non-Absorbable)
    • Made from man-made products
    • Must be removed from skin
    • Used superficially on body
  126. Suture Sizes
    • Larger sizes - number only
    • - bigger the number - bigger the suture
    • 3, 2, 1, 0

    • Smaller size - number -0
    • - bigger the number - smaller the suture
    • 1-0, 2-0, 3-0
  127. Minor Surgery Procedures
    • 1. Laceration repair
    • 2. Sebaceous cyst removal
    • 3. Incision and drainage (I&D)
    • 4. Biopsy
    • 5. Needle biopsy
    • 6. Cryosurgery
    • 7. Electrosurgery and cautery
    • 8. Chemical destruction
    • 9. Laser surgery
  128. Minor Surgery (MA Role)
    • 1. Assemble equipment and supplies
    • 2. Set up sterile tray and cover
    • 3. Instruct patient as needed
    • 4. Assist patient positioning
    • 5. When ready, remove drape from tray
    • 6. Wash hands, sterile gloves, assist
  129. Initial Surgical Scrub
    Six Minutes under hottest water you can handle
  130. Suture Removal
    • Grasp the knot
    • Place scissors next to skin under suture and cut
    • Pull suture toward incision to prevent re-opening
  131. Minor Surgery (Clean-Up)
    • 1. Remove gloves, wash hands
    • 2. Assist patient sitting up and dressing
    • 3. Review postop instructions
    • 4. Give written instructions
    • 5. Clean room / instruments - soak
    • 6. Restock exam room
    • 7. Dry instruments, package for autoclave

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