MA212 Final Study Guide Lab 4

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Beal, Kinn's, Lab 4 Final

fat soluble vitamins acquired from diet and the body are?

A, D, E, K

Upside down P waves normally occur in what lead?

AVR, Augmented Right Arm Lead. Lead aVR records electrical activity from midway between the left arm and left leg to the right arm. Lead aVR is usually a negative deflection. If it does not produce a negative deflection, you might have the electrodes or lead wires placed incorrectly.

Helicobacter pylori

bacterium that can cause ulcer, causes 80 to 90% of ulcers.

Spirometry testing patient is coaching

preparation of a patient for spirometry: No smoking or using bronchodilators 6 hours before test. Explain process and purpose of test. Demonstrate if necessary, explain coach and cheer on patient since the test is effort dependent. Patient should be sitting in proper posture for test because they may become dizzy.

ST segment elevations in all precordial leads

On the notes, it says it indicates a heart attack. Then it said ST waves below the baseline could also indicate a heart attack. (really not sure about this)

Hiatal hernia treatment

Part of stomach pushes through the hiatal sphincter of the diaphragm, causing GERD. Treatment: Prilosec, Nexium, Pepcid, Zantac; avoid caffeine and cigarettes, eat six small meals.

sigmoidoscopy examines what part of the colon

The flexible sigmoidoscopy can be done in the physician's office. The patient is positioned in a left side Sims position and draped. Examines sigmoid portion of colon with a sigmoidoscope.

extensive gastric by-pass risk

alters digestive process, is a malabsorptive disorder, can cause nutritional deficiencies. Also can get dumping syndrome after surgery with nausea, abdominal cramps, diarrhea, vertigo, tachycardia, diaphoresis

atelectasis

collapsed lung

empyema

accumulation of pus in the pleural space

hemoptysis

expectoration of blood

pleurisy

inflammation of the parietal pleura causing dyspnea and stabbing pain; friction rub may be auscultated

hypoxemia

low level of oxygen (O2) in the blood

dyspnea

shortness of breath, difficulty breathing

pneumothorax

a condition characterized by air in the pleural space causing the parietal and visceral pleura to separate which increases the chance of lung collapse; classified as traumatic, iatrogenic or spontaneous.

hemothorax

accumulation of blood and fluid in the pleural cavity

spirometry

PFT-pulmonary function test: to diagnose a pulmonary abnormality or to determine the extent of a pulmonary disease. 3 tries recorded. FEV=Forced Expiratory Volume is measured.

hypercapnia

excess levels of carbon dioxide in the blood; greater than normal amounts of CO2 in the blood

apnea

absence of breathing; a=not, pnea=breathe

URI

upper respiratory tract infections: URTI, URI: common cold, sinusitis, allergic reactions-hay fever

low sodium diet

recommended normal intake 2400mg. under 2000mg for low sodium diet

surgical asepsis

preventing contact with all microorganisms before they can enter the body; no microbial life. Autoclaving surgical instruments, using sterile gloves, maintaining sterile field, sterile draping, etc.

pulse oximeter

SpO2, reads oxygen saturation in blood on room air

heart healthy diet

only mono or polyunsaturated fats and oils; low fat or fat free dairy; whole grain bread, cereal, pasta, etc; dark, green leafy veggies; decreased sodium; fresh or frozen fruit; fish; chicken and turkey; limit eggs and red meat.

Visual acuity in elderly

May decline by the following:
presbyopia (nearsightedness), cataracts (cloud vision), glaucoma (peripheral vision loss), macular degeneration (central vision loss), color blindness, decreased depth perception, nyctalopia (night blindness), dry eyes, problems with glare, slow response to light changes.

carbohydrate

body's primary energy source, most abundant food source, cheapest $, Complex and simple, includes cellulose, starches, sugars, fiber from grains, legumes, tubers, fruits, plants

shigella

A type of food poisoning; symptoms: Bloody diarrhea, Fever, Nausea, Vomiting, Cramps

suture removal

face, eyelid, eyebrow, nose, lip 3-5 days scalp 6-8 days
chest, abdomen, penis 8-10 days
ear, hand 10-14 days
back, extremities, foot, joints 12-14 days (handout)

Allis tissue forceps

Grasping instrument. 6", 4x5 teeth. 6", 5x6 teeth. 7 1/4", 5x6 teeth (Has Sister Alice's praying hands with interlocking "fingers" at the end)

tachycardia symptoms

lots of QRS complexes on EKG; more than 100 bpm, tachycardia may be caused by: poor breathing = less oxygen, heart has to pump more blood around to get the same amount of oxygen distributed

SA node

Sinoatrial (SA) node (pacemaker)
Initiates heart at a rate of 60 - 100 beats per minute with electrical impulse that causes depolarization. Small, round structure that consist of Purkinje fibers, located in right atrium area. 1st item in list for electricity flow 1. sinoatrial (SA) node, 2. atrioventricular (AV) node, 3. Bundle of His (AV bundle), 4. bundle branches, and the 5.Purkinje fibers (network).

ground or reference electrode

always RL (right leg) Does not gather information.

single channel EKG

EKG machine that prints on a ribbon and you must manually switch the recording from lead to lead and then cut them out and put on the EKG mount for the chart.

secondary intention

Wound healing intention - Secondary or second: Tissue that is severely damaged and heals from the bottom of the wound outward

Wound healing intention - Primary or First

The clean, surgical wound that is sutured closed and heals quickly.

electrosurgery

Often used in minor surgery in an outpatient setting. Medical procedure that involves the use of electrical current to remove a nevus, wart, skin tag, or small malignant lesion or to coagulate or cut tissue.

avulsion

a tearing away or a forcible separation

cutting surgical instruments

Sharps instruments: cutting instruments: scalpels and dissecting, bandage, suturing and surgical scissors.

Gastroenterologist sutures for bowel

absorbable since you would not want to remove them, probably the chromic so they will stay in place as long as possible, (my guess)

saturated fat

An unhealthy fat to eat. Solid at room temperature like butter or bacon fat. From animal sources. Only plant products are tropical oils-palm and coconut. The only fat worse is trans fat that is artificially saturated. So butter is better than margarine.

emphysema

alveoli (air sacs) do not empty properly. With new air they expand more, eventually rupture and die. Causes diameter of chest front to back to expand, normally that should be about half the width of chest. Big barrel chest because waste air is not being expelled. subtype of COPD. obstructive disease: having to do with air flow; emphysema - outgoing breathing difficulty; shortness of breath and wheezing. At first, SOB (dyspnea) occurs with activity; as disease progresses, eventually at rest.

vagotomy

To treat ulcers. A procedure that involves cutting parts of the vagus nerve (a nerve that transmits messages from the brain to the stomach) to interrupt messages sent through it, therefore, reducing acid secretion

antrectomy

To treat an ulcer. An operation to remove the lower part of the stomach (antrum), which produces a hormone that stimulates the stomach to secrete digestive juices. Sometimes a surgeon may also remove an adjacent part of the stomach that secretes pepsin and acid. A vagotomy is usually done in conjunction with an antrectomy.

hypobilirubinemia

cannot find but the opposite is hyperbilirubinemia-an abnormally large amount of bilirubin in the circulating blood, resulting in clinically apparent icterus or jaundice when the concentration is sufficient.

clear liquid diet

anything that will be liquid at room temperature; used for diagnostic test preparation, and after GI surgeries

minerals

inorganic substances used in formation of hard and soft body tissues; necessary fpr muscle contraction, nerve conduction and blood clotting; ex: calcium, phosphorous, magnesium, sodium, iron, iodine, potassium

proctological exam position

A proctologist's office would probably have an exam table to accommodate the jack knife position. The knee chest position would also be helpful. The left lying Sim's position is used for sigmoidoscopy and colonoscopy. We only talked about Sim's in class.

BMR

Basal Metabolic Rate: amount of energy expended while at rest

catabolism

The aspect of metabolism in which complex substances are broken down to form simpler substances; catabolic reactions are particularly important in releasing chemical energy stored by the cell.

anabolism

Energy is required during building phase of metabolism in which simipler substances are combined to form more complex substances

catabolism + anabolism =

metabolism

metabolism

set of chemical reactions through which an organism builds up or breaks down materials as it carries out its life processes

satiety

the state produced by fulfillment of a specific need, such as hunger or thirst.

status asthmaticus

emergency situation, same asthma, uncontrolled asthma. CANNOT breathe. so swollen and plugged, pt. will be irritable, combative, uncomfortable. Need epinephrine, Benadryl, subQ or inhaled steroids, Nebulizer treatment, O2 high flow STAT, or they will die in front of you. DO NOT STOP TO DO PEAK FLOW OR SPIROMETRY TESTS.

staple removal

non-absorbable suture types include stainless steel staples; used on body surface, must be removed

electrolytes

minerals: sodium, potassium, chloride

trace minerals

minerals used in the smallest quantities: manganese, flourine, copper, cobalt, zinc

sanitizing and disinfecting instruments

Sanitize: Washing of instruments and equipment rids them of gross contamination and blood, body fluids, tissue and other contaminated debris. First level of clean. Disinfect: Consists of various chemicals that can be used to destroy many pathogens but not their spores. Second level of clean. Post-op instruments must be sanitized, disinfected, sterilized for next time or disposed of if they were intended for single use.

hay fever

upper respiratory tract infections, URTI, URI; allergic rhinitis treatment options: Benadryl, Zyrtec and other meds that make you sleepy; densensitizing treatment, inhaled medications, bronchodilators, antiinflammatories
Look up the nose to see...: bright red mucous membranes for a cold or virus; grey dullish membranes for an allergy

COPD

chronic obstructive pulmonary disease Ex. chronic bronchitis; chronic must occur for at least 2 months and at least 3x per year. obstructive: has to do with air flow; emphysema -outgoing, asthma-incoming, bronchitis

What does water do for the body?

hydration, helps with filtration of wastes

Crohne's disease

Crohn's disease is a form of inflammatory bowel disease (IBD). It usually affects the intestines, but may occur anywhere from the mouth to the end of the rectum (anus). With Crohn's disease the immune system can't tell the difference between normal body tissue and foreign substances with an overactive immune response that leads to chronic inflammation (autoimmune disorder). People with Crohn's disease have ongoing (chronic) inflammation of the gastrointestinal tract. There can be healthy patches of tissue between diseased areas. The inflammation causes the intestinal wall to become thick.

varicose veins

Dilated, tortuous, superficial veins in legs; contributing factors: pregnancy, obesity, prolonged standing or sitting, or sitting, heavy lifting, congenitally defective valves. Caused by venous insufficiency or valves not closing, allowing backward blood flow, causing vein to distend from increased pressure.

autoclave-steam

Autoclave temperature for steam sterilization: 250-254 F or 121-123 C. Autoclave requires-heat water and pressure: 15psi, 20 minutes minimum, 1 of 4 ways to sterilize

autoclave-dry heat

requires higher heat 320 F, and longer exposure 3-4 hours; done in an autoclave, for easily corroding instruments like sharp blades or things that should not get wet. 1 of 4 ways to sterilize

suture size-uses

overall: smallest possible for face 7-0 ideally, higher for joints and higher tension areas or deep sutures more like 4-0 (handout)

suture size

From largest to smallest 4, 3, 2, 1, 0 "aught", 1-0 or 0 or one-aught, 2-0 or 00 or two-aught, 3-0 or 000 or three-aught, 4-0 or 0000 or four-aught, 5-0 or 00000 or five-aught, 6-0 or 000000 or six-aught, 7-0 or 0000000 or seven-aught. The more zeros, the smaller the gauge.
(handout)

surgical instruments

must be sterile

chest leads

Precordial leads, horizontal across chest, V1, V2, V3, V4, V5, V6 The last six leads are the chest leads. Also known as precordial, these leads are located in front of (pre) the heart (cor). Unipolar because they are measured in one direction only. Numbered from V1 to V6. Unipolar.

peak flow meter

If healthy should be able to reach 80 to 100% of range based on age, height and gender. Based on Utah Mormon population by Dr. Crapo, persons living at high altitude, no caffeine use, no smokers. Required for some employment screenings.
FVC: peak flow test superbill code-"forced vital capacity"

pulse oximetry

measures the oxygen saturation of the blood and measures the pulse while clipped on patient's finger or ear. Spectrophotometry measures the amount of light absorbed by a substance, in this case the hemoglobin. Photoplethysmography uses the light to measure the patient's pulse.

sputum culture

sputum culture, best time: First thing in the morning after exposure to shower steam, brought up into a sterile container.

Pneumonia

Pneumonia: is fluid in lung tissues; symptoms include: coughing, clammy, wheezing, fatigue, anorexia; diagnosis by sputum culture or x-ray; tx: metered-dose inhaler, bronchodilator, nebulizer

elder abuse

physical or emotional abuse including financial exploitation, of an elderly person, by one or more of the person's children, nursing facility caregiver's or any others. MA may need to try to separate pt. from caregivers at the office to ask questions and assess situation.

sensorimotor changes

vision changes, hearing changes, sleep disorders may occur, nervous system slows down, reaction times are delayed, dermis loses mass, slower healing, easier bruising, tearing, muscular changes related to activity level, decreased GI function, heart rate decreases

risk factors for osteoporosis

decreased lifetime exposure to estrogen, post menopausal women over 50, slight build with a family history of O, history of amenorrhea, low dietary calcium intake, excessive intake of caffeinated soda, inactive lifestyle, smoking, alcohol abuse, hyperthyroidism, long term treatment with meds include anti-seizure drugs or heparin

cognitive ability

ability to think, reason and perceive. Reactive time may be a little slower but the process should not be impaired, that is NOT a normal part of aging.

high protein diet

Atkin's diet stresses low carbs, high protein, fats; is considered a fad diet. Fad diets can result in electrolyte loss, dehydration, kidney disease, gout, calcium depletion.

protein sources

complete (have all 22 amino acids) animal sources
incomplete (have some of the 22 amino acids but not all) whole grains, beans, nuts, seeds

AvR

Augmented Right Arm Lead. Lead aVR records electrical activity from midway between the left arm and left leg to the right arm. Lead aVR is usually a negative deflection. If it does not produce a negative deflection, you might have the electrodes or lead wires placed incorrectly.

quadrants

right upper quadrant RUQ
right lower quadrant RLQ
left upper quadrant LUQ
left lower quadrant LLQ

fiberoptic endoscopy

includes sigmoidoscopy (sigmoidoscope) (sigmoid portion of colon) and colonoscopy (colonoscope) (entire colon); also includes upper GI looking at esophagus and stomach with a flouroscope down the throat

Sim's position

The patient is positioned in a left side Sims position and draped. For sigmoidoscopy and colonoscopy.

Holter monitor

a portable system for recording the cardiac activity of a patient over a 24-hour period or longer. Pt. must keep a journal of all stressful events (rush hour, emotional stress, bowel movements, sex, stairs, physical activity) including time, duration, and what the activity was, especially during when any cardiologic symptoms occur.

Clubbing

more capillaries to ends of extremities trying to compensate for reduced oxygen and get more O2 to the tissue, expands the ends of the extremities, usually fingers, sometimes toes also

stroke

Cerebrovascular Accident (CVA)
vessel occluded or ruptures; symptoms depend on location and extent of the problem; TX: immediate administration of thrombolytic drugs; Risk factors: hypertension, diabetes, smoking, hyperlipidimia; is one of the things that could reduce lung expansion-(may keep both sides of ribs from expanding)

3 basic functions of EKG

EKG machine-recorder, amplifier, sensor: the sensor is the electrodes/lead portion of the machine capturing the data; the amplifier would amplify the data into something to be interpreted, the computer part of the machine; the recorder is the part of the machine that records the data on the EKG paper

EKG electrodes

are disposable, 12-Lead EKG uses 10 electrodes. Electrodes are small sensors placed on the skin to receive the electrical activity from the heart, and leads are covered wires that conduct the electrical impulse from the electrodes to the EKG machine.

EKG tracing, time is recorded on the?

horizontal axis-represents time: speed, rate, 0.04 seconds, 25 mm per second 25 little squares or 5 big squares per second. 1,500 small blocks equals 1 minute. 300 big blocks equals 1 minute. horizontal on EKG paper, each little square is 1 mm At the normal paper speed, one second equals 25 mm, or five heavy lines. Therefore, each vertical heavy line represents 0.20 of second.

bradycardia

few QRS complexes on EKG: less than 60bpm

dressing

Purpose: protects wound from injury and contamination; maintains constant pressure minimizing bleeding and swelling; holds wound edges together; absorbs drainage and secretions. Dressings are put directly over or in a wound. Because it is going directly in or on an opening into the body, it must be sterile.

bandage

bandages cover everything including the dressing, so they must be clean but not necessarily sterile. Purpose of bandage: Helps hold dressing in place; improve circulation; support or reduce tension or prevent movement.

consent form

Required before all minor surgical procedures. It is the provider's responsibility to get this signed by the patient. It is the MA's responsibility to make sure this was done but NOT to get the consent. Consent must be informed consent while the patient is alert and can understand and ask questions prior to the procedure.

lidocaine

a common injectable anesthesia. "-caine" indicates anesthesia.

epinephrine

may be added to anesthesia, will have red labelling. It is a vasoconstrictor and should not be used on Pts with hypertension or on areas that are extremities. benefit is less bleeding during procedure, also a bronchodilator given to pts. with trouble breathing

ecchymosis

a hemorrhagic skin discoloration commonly called "bruising"

obstructive lung

has to do with air flow, in or out; emphysema -outgoing, asthma-incoming, bronchitis

PFTs and spirometry

Peak flow test-tests air flow; spirometry PFT pulmonary function test, FEV Forced Expiratory volume-test volume or lung capacity

ulcers

An ulcer is an open sore, or lesion, usually found on the skin or mucous membrane areas of the body; Causes gnawing or burning pain. Less common ulcer symptoms include: Belching, Nausea, Vomiting, Poor appetite, Loss of weight Complications: Bleeding, Perforation, Narrowing and obstruction.

obesity risks

hypertension, diabetes mellitus type 2, coronary artery disease, stroke, gallbladder disease, osteoarthritis, sleep apnea, hypercholesteremia, certain types of cancer: breast, colon, esophageal, kidney, non-Hodgkin's lymphoma, pancreatic.

electrode placement

1st 3 leads, standard limb/bipolar leads.
Lead I: Right Arm
Lead II Left Arm
Lead III Left Leg
Right leg: ground or reference electrode.
six chest/precordial/unipolar leads.
horizontal across chest, V1, V2, V3, V4, V5, V6 located in front of (pre) the heart (cor)

asepsis

absence of pathogens or disease-producing organisms; 2 types: medical asepsis and surgical asepsis

vitamin K

mineral, electrolyte, potassium, must be eaten consistently by patients on Coumadin

sterile surgical field

any sterile surface with ONLY sterile items on it. Usually on a sterile towel on a mayo stand.

EKG machine recording speed

0.04 seconds, horizontal on EKG paper, each little square is 1 mm At the normal paper speed, one second equals 25 mm, or five heavy lines. Therefore, each vertical heavy line represents 0.20 of second. 25 mm per second. 25 little squares or 5 big squares per second. 1,500 small blocks equals 1 minute. 300 big blocks equals 1 minute.

orthostatic hypotension

also called postural hypotension; increased incidence in elderly; fall in blood pressure when person changes from recumbent position to standing.

ferrous sulfate taken with

This medication should be taken on an empty stomach, at least 1 hour before or 2 hours after eating.
Ferrous sulfate drops come with a special dropper for measuring the dose. Ask your pharmacist to show you how to use it. The drops may be placed directly in the mouth or mixed with water or fruit juice (not with milk). (from Medline Plus)

SOB and dyspnea would be documented as

Part of "S" Subjective, reported by patient or as "O" observed by medical assistant.

Lead I

standard lead, bipolar lead, 1st of the 1st 3 leads, standard limb lead. Right Arm placement, Lead I records RA(-) to LA(+). Measures flow of electrical current in 2 directions at the same time.

wandering baseline

Wandering baseline shift, occurs when the tracing drifts away form the center of the graph paper. Baseline shift can have many causes. Typically, it is due to improper electrode application such as the following: Too loose or incorrect electrode application; Tension or pulling on electrode lead wires; Too little electrode gel or solution; Old or dried out electrode gel or solution; Corroded or dirty electrodes; Oil, lotion, or dirt under the electrodes, ALSO breathing

Einthoven's triangle

Einthoven is the scientist credited with the developing the first EKG machine. The Einthoven triangle is formed by three of the limb electrodes; those on the right arm, the left arm, and the left leg. The right leg is used only as a ground or reference electrode.

osteoporosis

is one of the things that could reduce lung expansion- pneumothorax, stroke, scoliosis, osteoporosis, (may keep both sides of ribs from expanding)

vitamin D

synthesized by skin using sunlight, about 30 minutes per day in sun is enough

food label ingredients

listed with largest quantity ingredient first down to smallest quantity ingredient as last in list

caloric intake exceeds output

fuel(glucose and fats) not used will be stored in adipose tissue/fat cells; a cause of obesity

atherosclerosis

Atherosclerosis is a disease of the arteries in which fatty material and plaque are deposited in the wall of an artery, resulting in narrowing of the arterial lumen and eventual impairment of blood flow.

crackles and wheezing in lung base

Crackles or rales are because of fluid filled bronchioles. Wheezing is because of restricted bronchioles. (our notes)

Crackles: pneumonia, atelectasis, pulmonary fibrosis, acute bronchitis, or bronchiectasis, pulmonary edema.
Wheezing: lung disease; the most common cause of recurrent wheezing is asthma attacks. From internet, not the best source.

"on the side"

an area separate from the sterile field, but should be nearby; can turn your back on it, may have unopened sterile items and all items will at least be clean.

medical asepsis

destroying transient microorganisms after they leave the body; hand washing, disinfecting surfaces in the exam room when patient leaves, sanitizing stethoscope, etc.

arteriosclerosis

arteries become thick and stiff (hardening of arteries)

wheeze

whistling or sighing sound heard on auscultation that results from narrowing of the lumen of the respiratory passageway (associated with emphysema, pneumonia and asthma)

rales

a bubbling or popping sound heard on auscultation produced by passage of air through bronchi that are constricted or contain secretions, abnormal crackling sound made during inspiration

tachycardia (pic)

bradycardia (pic)

Einthoven's triangle (pic)

Precordial lead placement (pic)

wandering baseline (pic)

atherosclerosis (pic)

10 leads make 12 circuits

The 10 lead wires produce 12 different lead circuits consisting of one or more wires from the electrodes to the electrocardiograph. The 12 leads are made up of three different types of leads; three standard limb leads, three augmented leads, and six chest leads. The 12 circuits produce 12 different tracings or views of the heart. A 12-Lead EKG is actually recorded by only 10 lead wires, which, when attached to the chest and the limbs (arms and legs), provide the 12 different views for the 12-Lead tracing. Six of these leads attach to the chest electrodes, and the other four attached to the electrodes on the arms and legs.

blood flow

Deoxygenated blood: Superior and inferior venae cavae > right atrium > tricuspid valve > right ventricle > pulmonary semilunar valves > pulmonary trunk > Pulmonary arteries > lung tissue(Pulmonary circulation) > Pulmonary veins(oxygenated blood) > left atrium > bicuspid valve > left ventricle > aortic semilunar valves > aorta > body tissues (systemic circulation) returning deoxygenated blood to inferior and superior venae cavae

conduction pathway

1. sinoatrial (SA) node,
2. atrioventricular (AV) node,
3. Bundle of His (AV bundle),
4. bundle branches,
5.Purkinje fibers (network).

Stroke results

If occlusion is in left side of brain: right side hemiplegia, slow, cautious behavior, speech and memory deficits
If occlusion is in right side of brain: left side hemiplegia, quick, impulsive behavior, perceptual and memory deficits

ministroke

Transient Ischemic Attacks (TIAs)
seconds to minutes, bloodflow is inadequate in brain, symptoms pass quickly, may cause numbness, weakness, headaches, vertigo, loss of balance or coordination, difficulty talking and understanding, diplopia; need endarterectomy to prevent CVA from occurring

obesity

an excessive accumulation of body fat; BMI = or > than 30. may be caused by excessive caloric intake in relation to the expenditure of calories or because of certain endocrine imbalances

Abdominal Quadrants (pic)

Abdominal Regions

water soluble vitamins

excess is excreted, must be replenished daily. Vitamin C and all B vitamins: thiamine/B5, pyroxidine/B6, cyanocobalamin/B12, folic acid, niacin/B3, etc.

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