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Terms in this set (245)
Parts of the medical history include:
1. chief complaint
2. history of present illness (HPI)
3. past, family and social history (PFSH)
4. review of systems (ROS)
Define chief complaint
what brings the patient in to see the physician
Define history of present illness (HPI)
explanation of the chief complaint to determine:
1. onset of illness
2. associated symptoms
3. what the patient has done to treat the illness
Define past medical history
1. all health problems
2. major illnesses
4. current medications complete with reasons for taking them
Define family history
summary of health problems of siblings, parents and other blood relatives
Define social history
1. marital status
3. educational attainment
5. use of alcohol/tobacco/drugs
Define review of systems
orderly and systematic check of each organ and system of the boy by questions.
What are the 3 vital signs that are necessary for life?
3. heart function (blood pressure)
What are the four vital signs of body function?
4. blood pressure
What is the normal range of body temperature?
Define body temperature
the balance between heat production and heat loss
Body temperature is regulated by what structure?
Site for most accurate body temperature
Least accurate site for body temperature
3 types of fever
Define intermittent fever
fluctuating fever that returns to or below baseline then rises again
Define remittent fever
fluctuating fever that remains elevated: it does not return to baseline temperature
Define continuous fever
a fever that remains constant above the baseline: it does not fluctuate
Which is the most common site for temperatures
In patients who have just finished eating, drinking, or smoking, how long should you wait before taking a temperature
Patients with heart disease should not have which temperature taken?
Normal pulse range
Most accurate pulse
Normal respiratory range
12 to 20 per minute in adults
3 respiratory rate abnormalities
temporary complete absence of breathing which may be a result of a reduction in the stimuli to the respiratory centers of the brain
respiration rate of greater than 40/minute. It is transient in the newborn and maybe caused by hysteria in the adult
decrease in the number of respirations. This occurs during sleep, or certain diseases.
Define respiratory rhythm
refers to the pattern of breathing. Can vary with age: infants have an irregular rhythm, while adults have regular.
2 abnormal respiratory rythms
Define Cheyenne-Stokes breathing rate
a regular pattern of irregular breathing rate
difficulty or inability to breathe unless in the upright position
Patient position when the head is 90 degrees upright
Define depth of respiration
the amount of air that is inspired and expired during each respiration
Name 2 abnormalities in the depth of respiration
state in which reduced amount of air enters the lungs resulting in decreased oxygen level and increased carbon dioxide level in blood. It can be due to breathing that is too shallow, or too slow, or due to diminished lung function
abnormal increase in the depth and rate of breathing
state in which there is an increased amount of air entering the lungs
Define blood pressure
the amount of force exerted by the blood on the peripheral arterial walls
How is blood pressure expressed
mm of Hg
The appropriate width of a cuff is what?
40% of the circumference of the limb
The appropriate length of the cuff is what?
80% of the circumference of the limb
If the blood pressure cuff is too short or narrow, how does this effect bp readings?
false high readings
The bp cuff is centered over which artery
What is the location of the bp cuff in relation to the anticubital crease?
If the brachial artery is far below the heart level, how will this effect the blood pressure
If the brachial artery is far above heart level, how will this effect the blood pressure reading
What is the most common artery to use for blood pressure?
How high should the bp cuff be inflated above the palpatory systolic pressure
What is the rate of release of pressure when taking a bp?
2 to 3mm Hg per second
When to you take the systolic bp?
the level at which you hear the sounds of at least two consecutive beats
When do you take the diastolic bp?
When beats disappear
What are the 7 common errors in blood pressure measurements?
1. improper cuff size
2. the arm is not at heart level
3. cuff is not completely deflated before use
4. deflation of the cuff is faster than 2-3mm Hg per second
5. the cuff is re-inflated during the procedure
6. improper cuff placement
7. defective equipment
Define anthropometric measurements
comparative measurements of the body
Why is length used in anthropometric measurements?
because infants and toddlers are unable to stand for a height measurement
What are the 4 principles of physical examination?
What does inspection focus on during the physical exam?
1. general appearance
2. state of nutrition
3. body habitus
5. posture and gait
use of the sense of touch to determine the characteristics of an organ
tapping or striking the body, usually with the fingers or a small hammer to determine the position, size and density or the underlying organ or tissue.
listing to sounds produced by internal organs. Usually done to evaluate:
What is the medical assistant's role in the physical examination?
1. room preparation
2. patient preparation
3. assisting the physician
What sources does the physician use to make a diagnosis?
1. past medical history
2. physical examination
3. laboratory tests
What position is used for most physical examinations?
horizontal recumbent position
Describe the horizontal recumbent position
patient lies on back with legs extended. Arms may be above the head, alongside the body, or folded on the chest
Describe the dorsal recumbent position
patient on back with knees flexed and soles of the feet flat on the exam table.
MA's responsibility for patient in the dorsal recumbent position
fold a sheet once across the chest and fold a second sheet crosswise over the thigs and legs so that the genital area is easily exposed
What is Fowler's Position used for?
2. ease breathing
3. for patients with cardiovascular conditions
4. respiration problems
5. examination of the upper body and head
Describe Fowler's position
sitting or semi-sitting position where the back of the examination table is elevated to either 45 degrees (semi-fowler's) or 90 degrees (high-fowler's). Knees raised slightly by placing a pillow underneath, but usually the legs rest flat on the table
Abnormally fast or deep respiration resulting in the loss of carbon dioxide from the blood, thereby causing a decrease in blood pressure and sometimes fainting.
Horizontal Recumbent Position
Used for most physical exams
horizontal recumbent position
Dorsal Recumbent Position
Examination position in which the knees are flexed and the soles of the feet are flat on the bed
dorsal recumbent position
elevate the head 45 degrees
elevate the head 90 degrees
Used for patients with cardiovascular or respiratory problems
Dorsal Lithotomy Position
Used for examination of the pelvic organs
dorsal lithotomy position
Position used in the examination of the posterior aspect of the body, including the back and spine
Which position cannot be used with an unconscious patient or one with an abdominal incision or breathing difficulty?
Position used for rectal examinations
Which position cannot be used when leg injuries or arthritis is present
Which position is used for rectal and vaginal examinations and as treatment to bring the uterus into normal position?
Describe trendelenburg position
head 45 degrees lower than the body.
When is the trendelenburg position used
1. surgical procedures of the pelvis and abdomen
Who is responsible for the identification of the various hazards in the workplace and for the creation of rules to minimize exposure to such hazards.
OSHA (Occupational Safety and Health Administration)
What is the most important thing to do when there is a workplace accident?
report it to the supervisor immediately
All chemicals used must have an accompanying what?
Material Safety Data Sheet (MSDS)
If the skin or eyes come in contact with any chemicals, immediately wash the area with water for at least how long?
How do you control external hemorrhage?
elevating the affected part above the level of the hear and apply direct pressure
insufficient return of blood flow to the heart, resulting in inadequate supply of oxygen to all organs and tissues of the body.
What are the common symptoms of shock?
1. pale, cold, clammy skin
2. rapid, weak pulse
3. increased shallow breathing rate
4. expressionless face/staring eyes.
First Aid for shock
1. maintain an open airway
2. call for assistance
3. place victim in trendelenburg position
4. attempt to control bleeding or cause of shock (if known)
5. keep victim warm
6. patient is NPO
What is the ABC of CPR
Define agents of infection
When an infectious disease is identified according to the specific disease-causing microorganism, the disease may be prevented by the use of what?
1. anti-infection drugs
2. infection control practices
Define the portal of exit
the method by which an infectious agent leaves its reservoir
What are the 5 modes of transmission?
1. contact (direct or indirect)
4. common vehicle
5. vector borne
Define portal of entry
a way that allow the infectious agent access to the susceptible host
Name 3 common portals of entry
1. broken skin
2. mucous membranes
3. body systems
Define a susceptible host
an organism that is not resistant or immune to an infectious agent
Name the 8 anthropometric measurements
5. head circumference
6. basal metabolic index (BMI)
7. waist to hip ratio
8. percent body fat
Which anthropometric measurement is only done in the infant
The horizontal recumbent position is used for what?
checking the abdomen
The dorsal recumbent position is used for what?
pelvic exams in hospital beds and foley insertions
High-Fowler's position is used for what?
Which position is used for kidney stones, vasectomy, and bladder stones?
dorsal lithotomy position
Which position should you never leave the patient in?
Which position is used to insert a suppository?
In which position does the bladder move forward?
What's another name for Trendelenberg position?
Which position is used for syncope
What is the chain of infection?
2. portal of exit
3. mode of transmission
4. portal of entry
5. susceptible host
What is used to prevent diseases?
Where do agents initially live?
in a reservoir
Most illnesses are transmitted via what part of the body?
the triangle of death
What is the difference between a vector and a fomite?
a vector moves, a fomite doesn't
Define medical asepsis
the destruction of pathogenic microorganisms after they leave the host.
How is medical asepsis accomplished?
by standard and thransmission based precautions.
What is disinfection
destruction of many pathogenic microorganisms on inanimate objects only.
What is the least expensive disinfection solution?
bleach and water
To make a disinfecting solution, what is the ration of bleach to water?
Where can you NOT use a disinfectant?
in an invasive procedure or on or in a body orifice
Define surgical asepsis
Every microorganism is destroyed before an invasive procedure
What are the 4 methods of sterilization?
2. dry heat
3. chemical sterilization
Where is gas sterilization used and for what?
used in hospitals for sterilization of:
2. bedside tables
3. hospital beds
What is dry heat sterilization used for?
instruments that easily corrode (IE rubber tubing, or flexible tubing)
What is important to know about chemical sterilization?
used as a disinfectant, and requires hours of exposure
What is the most popular form of sterilization?
steam sterilization (aka autoclave)
At what temperatures does an autoclave run?
What are the 3 principles of an autoclave?
What is the most important way to stop the spread of infection?
What is the function of plain soap
to remove transient bacteria
Hand asepsis requires what?
an antimicrobial soap to kill or inhibit transient microorganisms
What can you assume about any bodily fluid?
it contains blood
What is the only bodily fluid not to contain blood
What are the 4 basic PPE devices?
Where does gas exchange occur?
at the capillaries
Why does gas exchange occur at the capillaries?
because it's one cell layer thick
When is dermal puncture used?
1. when small amounts of blood is needed
2. the elderly
When is venipuncture contraindicated?
3. the patient requires blood glucose monitoring
4. burns and scars
5. obese patients
6. intravenous therapy
Where is dermal puncture performed on an infant?
What parts of the infant heel are used for dermal puncture?
medical and lateral surfaces of the heel
What are the 2 types of lancets used in dermal puncture?
Define needle gauge
the diameter of the lumen of the needle.
What is the relationship between the number and the needle gauge?
the higher number, the smaller the needle lumen
When is a 23 gauge needle used?
on small and/or fragile veins
When is a 20-21 gauge needle used?
on routine adults
When is a 16 gauge needle used?
used by blood banks
What happens if you used a small gauge needle under high pressure?
What sites are normally used for capillary punctures in the adult?
the medial and lateral surface of the 3rd or 4th digits
What sites are normally used for capillary punctures in the infant?
Why isn't the thumb used for capillary punctures?
Why isn't the 2nd digit used for capillary punctures?
Why isn't the 5th digit used for capillary punctures?
increased chance to hit bone causing bone infection (osteitis)
What surfaces are used for capillary punctures in the infant?
medial and lateral platar surfaces of the infant heel.
What is used to increase blood flow to the infant heel?
heel warmer for 3 - 5 minutes before capillary puncture
Never use what on a child less than 2 years old?
Why do you never us a bandage on a child less than 2 years of age?
The child may try to eat it. It becomes a choking hazard
What are the 2 hazards encountered by going to far lateral or medial on the fingers?
1. piercing the bone
2. piercing the base of the nail
Chain of custody is used when?
In legal and police cases
What must happen every time the sample changes hands?
the sample must be signed for.
When does the chain of custody end?
when test results are reported
What is the order of draw?
1. Yellow - Culture Tubes
2. Light blue - Sodium Citrate
3. Red - nothing
4. Green - Heparin
5. Lavender - EDTA
6. Gray - Blood glucose tubes
Which culture tube is drawn first, aerobic or anaerobic?
What equipment is necessary before doing a venipuncture?
2. 70% alcohol swabs
3. Double pointed safety needles
4. Needle holder
6. Vacutainer tubes
7. Gauze pads
When drawing blood cultures, what is used to prep the skin?
What is the correct procedure for using provodone?
start at the center, and in a circular motion, move toward the outside.
The tourniquet is positioned where?
3-4 inches above the anticubital space
What is possible if the tourniquet is left on for more than 1 minute?
What is the fluid in unclotted blood called?
What is the fluid in clotted blood called?
Which tubes are inverted 8-10 times?
Which tubes are inverted 3-4 times?
Which tubes are inverted 5 times?
Define the hub
the point where the needle attaches to the syringe or the needle holder
When are syringes used?
when there is a concern that the strong vacuum in a tube might collapse the vein
The heart acts as how many pumps?
Each side of the heart has how many valves?
What is the function of the pulmonary circulation?
to carry deoxygenated blood from the right ventricle to the lungs, and returns oxygenated blood to the left atrium.
What is the function of the systemic circulation?
carries oxygenated blood from the left ventricle throughout the body
What is the valve between the right atrium and ventricle?
the tricuspid valve
what is another name for the tricuspid valve?
right atrioventricular valve
what is the name of the valve between the right ventricle and the pulmonary artery?
the pulmonic valve (semilunar valve)
How many valves are there are the on the left side of the heart
what is the name of the valve between the left atrium and ventricle?
the bicuspid (mitral) valve
What's another name for the bicuspid valve?
left bicuspid (atrioventricular) valve
What is the name of the valve between the left ventricle and the aorta?
aortic (semilunar) valve
what is the name of the innermost layer of the heart
what is another name for the innermost layer of the heart?
the endothelial layer
What is the mane of the middle, or muscular layer of the heart?
What is the name of the outermost layer of the heart?
What is found in the outermost layer of the heart?
the coronary blood vessels.
What are the blood vessels of the body?
7 superior/inferior vena cavae
Blood vessels are composed how how many layers
What is the outermost layer oa a blood vessel called?
What is the middle layer of a blood vessel called?
Tunica medial (aka tunica muscularis)
Arterial vessels carries what type of blood
What is the main anatomic functional rule of arteries
blood in arteries travel away from the heart
What is the main anatomic function rule of veins?
to carry blood to the heart
The average adult has how many liters of blood?
Plasma is what percentage of the blood?
Formed elements are what percentage of the blood?
What constitutes the formed elements of the blood?
3. thrombocytes (platelets)
Erythrocytes comprise what percentage of the formed elements?
What is the origin of all blood cells?
stem cells in the bone marrow
What is the normal life span of an RBC?
120 days (4 months)
What is the function of the leukocytes?
protection against infection
Neutrophils function to:
engulf and digest bacteria
Lymphocytes function in:
Monocytes are involved with:
1. interacellular infections
Eosinophils are involved with:
2. skin infections
3. parasitic infections
What are the 4 stages of hemostasis:
1. vascular phase
2. platelet phase
3. coagulation phase
What is the vein of choice for venipuncture?
median cubital vein
Which is the 2nd choice vein for venipuncture?
Which is the only vein that can be palpated in the obese patient?
Why is the basilic vein the least desirable for venipuncture?
close to the brachial artery and the nerve
Which types of veins are unsuitable veins for venipuncture?
Veins of the anticubital fossa
Veins of the arm
What is the most common antiseptic used for venipuncture?
70% isopropyl alcohol
If doing a blood culture, what antiseptic is used?
What antiseptic is used for blood cultures if the patient is allergic to iodine?
What is the common length of venipuncture needles?
1" - 1.5"
What is the most common gauge needle for adult venipuncture?
What bore is used for blood donation?
Why are needles smaller than 23 gauge not used for blood draw?
they cause hemolysis
When are butterfly needles used?
3. small veins
If the vacutainer system cannot be used, what size syringe is used?
What is the most common length of the butterfly needle?
1/2" - 3/4"
What is the most common complication of phlebotomy?
What is hemoconcentration?
the increase in proportion of formed elements to plasma caused by the tourniquet being left on too long.
What is phlebitis?
inflammation of a vein as a result of repeated venipuncture.
What are petechiae?
tiny non-raised red spots that appear on the skin from rupturing of the capillaries due to the tourniquet being left on too long or too tight.
What is thrombophlebitis
inflammation of a vein with the formation of a clot
What is a thrombus
blood clot usually a consequence of insufficient pressure applied after the withdrawal of the needle
What is septicemia
systemic infection associated with the presence of pathogenic organism introduced during a venipuncture.
What is trauma as related to venipuncture?
injury to underlying tissues caused by probing of the needle
What blood tests require fastion
Define a fistula
the permanent surgical connection between an artery and a vein
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