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NHA CCMA Study Guide
Terms in this set (544)
Chief Complaint Definition
The reason why the patient came to see the physician.
Chief Complaint Abbreviation
History of Present Illness Abbreviation
History of Present Illness Definition
This is an explanation of the CC to determine the onset of the illness; associated symptoms; what the patient has done to treat the condition, etc.
Past, Family and Social History Abbreviation
Past Medical History Definition
Includes all health problems, major illnesses, surgeries the patient has had, current medications complete with reasons for taking them, and allergies.
Family History Definition
Summary of health problems of siblings, parents, and other blood relatives that could alert the physician to hereditary and/or familial disease.
Social History Definition
Includes marital status, occupation, educational attainment, hobbies, use of alcohol, tobacco, drugs, and lifestyles.
Review of Systems Abbreviation
Review of Systems Definition
This is an orderly and systematic check of each organ and system of the body by questions. Both positive and pertinent negative findings are documented.
3 Body Processes Necessary for life are:
Body Temperature, Respiration, Heart Function
4 Vital Signs of Body Function are:
Temperature, Pulse, Respiration, Blood Pressure
Define Body Temperature
Is a balance between heart production and heart loss in conjunction with each other, maintained and regulated by the hypothalamus.
Are used to measure temperature using the Fahrenheit and Centigrade or Celsius scale.
Mouth, Rectum, Ear (Tympanic Membrane), and the axilla (underarm).
Normal Temperature Range for Rectal
98.6F to 100.6F
37.0C to 38.1C
Normal Temperature Range for Oral
97.6F to 99.6F
36.5C to 37.5C
Normal Temperature Range for Axillary
96.6F to 98.6F
35.9C to 37.0C
Normal Temperature Range for Tympanic Membrane
Presence of Fever
Absence of Fever
Elevated body temperature beyond normal range.
Fluctuating fever that returns to or below baseline then rises again.
Fluctuating fever that remains elevated; it does not return to baseline temperature.
A fever that remains constant above the baseline; it does not fluctuate.
Is the most common method of measurement.
Oral Temperature is not taken from what patients:
-infants and children less than six years old
-patients who has had surgery or facial, neck, nose, or mouth injury
-those receiving oxygen
-those with nasogastric tubes
-patients with convulsive seizure
-patients with altered mental status
How long after a patient eats, smokes or drinks do you wait to take an oral temperature?
When taking an oral temperature how long do you leave the thermometer in the patient's mouth?
Is taken when oral temperature is not feasible.
Rectal Temperature is not taken from what patients:
-patient's with heart disease
-patients with rectal disease or disorder or has had rectal surgery
-patients with diarrhea
Is the least accurate and is taken only when no other temperature site can be used.
When taking an axillary temperature how long should the thermometer be held in place?
Is useful for children and confused patients because of the speed of operation.
Tympanic Temperature is not taken from what patients:
-patients with an ear disorder or ear drainage
When taking a Tympanic Temperature:
A covered probe is gently inserted into the ear canal and temperature is measured with seconds (1-3 seconds).
What is the normal range for an adult pulse:
60 to 100 beats per minute
The site most commonly used for taking a pulse is:
The radial artery (found in the wrist on the same side as the thumb).
When taking a pulse at the radial artery it is felt with the:
First two or three fingers (never with the thumb) and usually taken for 30 seconds multiplied by two to get the rate per minute.
(Taking a pulse at the radial artery) If the rate is unusually fast or slow then:
Count it for 60 seconds
The _____ _____ is a more accurate measurement of the heart rate and it is taken over the apex of the heart by auscultation using the stethoscope.
Taking an apical pulse is used for patients with:
Irregular heart rate and for infants and small children.
Rate, Rhythm, and Depth
Is the number of respirations per minute.
Normal Adult Range of Respiratory Rate
12 to 20 per minute
What counts as one respirations:
One inspiration (inhale) and One Expiration (exhale).
How is a Respiratory Rate calculated:
Count respirations for 30 seconds then multiplied by two or count for a full minute.
This is a temporary complete absence of breathing which may by result of a reduction in the stimuli to the respiratory centers of the brain.
This is a respiration rate of greater than 40/min. It is transient in the newborn and maybe caused by the hysteria in the adult.
Decrease in numbers of respirations. This occurs during sleep. It may also be due to certain diseases.
Define Respiratory Rhythm
Refers to the pattern of breathing. It can vary with age: infants have an irregular rhythm while adults have regular.
This is a regular pattern of irregular breathing rate.
This is difficulty or inability to breath unless in an upright position.
Define Respiratory Depth
Refers to the amount of air that is inspired and expired during each 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 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
This is the measurement of the amount of force exerted by the blood on the peripheral arterial walls and is expressed in millimeters (mm) of mercury (Hg).
Blood Pressure Abbreviation
BP consist of two components:
The Highest (systole) and lowest (diastole) amount of pressure exerted during the cardiac cycle.
Common errors in blood pressure measurements:
-Improper Cuff Size
-The arm is not at heart level
-Cuff is not completely deflated before use
-Deflation of the cuff is faster than 2-3mmHG per second
-The cuff is re-inflated during the procedure without allowing the arm to rest for 1-2 minutes between reading
-Improper cuff placement
Define Anthropometric Measurements
Refers to comparative measurements of the body.
What age groups use Length, Height, Weight, Weight-for-Length, and Head Circumference - Anthropometric Measurements:
Are used to assess growth and development in infants, children, and adolescents.
What age groups use Height, Weight, Body Mass Index (BMI), waist-to-hip ratio, and % of body fat - Anthropometric Measurements:
Are the measurements used for adults.
The 4 principles of a physical examinations:
Inspection, Palpation, Percussion, Auscultation
Which provided an enormous amount of information. The observer uses observation to detect significant physical features or objective data.
Inspection focuses on certain aspects of the patient:
General Appearance, State of Nutrition, Body Habitus, Symmetry, Posture and Gait
The examiner uses the sense of touch to determine the characteristics of an organ system.
This involves tapping or striking the body, usually with the fingers or a small hammer to determine the position, size and density of the underlying organ or tissue.
This involves listening to sounds produced by internal organs. It is usually done to evaluated the heart, lungs, and the abdomen.
The Medical Assistant's Role In the Physical Examination:
-Assisting the Physician
Horizontal Recumbent Position
Is used for most physical examinations. The patient lies on his/her back with legs extended. Arms may be above the head, alongside the body or folded on the chest.
Dorsal Recumbent Position
Is when the patient is on his/her back with knees flexed and soles of feet flat on the bed. The MA will need to fold a sheet once across the chest and fold a second sheet crosswise over the thighs and legs so that genital area is easily exposed.
Is used to promote drainage or to ease breathing. A sitting or semi-sitting position where the back of the examination table is elevated to either 45 degrees (45 degrees (Semi-Fowler's) or 90 degrees (High-Fowler's).
Dorsal Lithotomy Position
Is used for examination of pelvic organs. This position is similar to the dorsal recumbent position, except that the patient's legs are well separated and thighs are acutely flexed. The feet are usually placed in stirrups and a folded sheet or bath blanket is places crosswise over thighs and legs so that genital area is easily exposed.
The Pone Position
Is used to examine the back. The patient lies on his/her abdomen with head turned to one side for comfort, the arms may be above head or alongside the body.
The Sim's Position
Is used for rectal examination. The patient is on his/her left side with the right knee flexed against the abdomen and the left knee slightly flexed. The left arm is behind the body; the right arm is placed comfortable.
The Knee-Chest Position
Is used for rectal or vaginal examinations and as treatment to bring uterus into a normal position. The patient is on his/her knees with his/her chest resting on the bed and elbows resting on the bed or arms above head. The head is turned to one side.
The patient is placed flat on the back, face up, the knees flexed and legs hanging off the end of the table, with the legs and feet supported by footboard. The table is positioned with the head 45 degrees lower than the body. This position is used primarily for surgical procedures of pelvis and abdomen.
OSHA stands for
Occupational Safety and Health Adminstration
Responsible for the identification of the various hazards present in the work place and for the creation of rules and regulations to minimize exposure to such hazards.
Physical Hazards - Electrical Safety Regulations:
-Use only ground plugs that have been approved by Underwriters' Laboratory (UL)
-Never use extension cords
-Avoid electrical circuit overloading
-Inspect all cords and plugs periodically for damage
-Use a surge protector on all sensitive electronic devices
-Before servicing, UNPLUG the device from the electrical outlet
-Use signs and/or labels to indicate high voltage or electrical hazard
Chemical Hazards - Chemical Safety Regulations
-If skin or eyes come in contact with any chemicals, immediately wash the area with water for at least 5 minutes
-Store flammable or volatile chemicals in a well-ventilated area
-After use, immediately recap all bottles containing toxic substances
-Label all chemicals with the required Material Safety Data Sheet (MDSD)
Material Safety Data Sheet Abbreviation
Patient's have the Right to:
-Information about pain and pain relied
-A caring staff who believes in your reports of pain
-A care staff with concern about your pain
-A quick response when you report your pain
Patient's have the responsibility to:
-Ask for pain relief when you pain first starts
-Help those caring for you to asses you pain
-Tell those caring for you if your pain is not relieved
-Tell those caring for you about any worries that you have about taking pain medications
-Decide if you want your family and/or significant others to aid in your relief of pain
Primary assignment is to assist you in exercising your rights as a patient.
Good Samaritan Law
This law deals with the rendering of first aid by health care professionals at the scene of an accident or sudden injury.
Needle Stick Prevention Act
OSHA has put into force the Occupational Exposure to Bloodborne Pathogen (BBP) Standard when it was concluded that healthcare employees face a serious health risk as a results of occupational exposure to blood and other boy fluids and tissues..
Bloodborne Pathogen Abbreviation
Bloodborne Pathogen Standard
-Revision and updating of the exposure control plan
-Solicitation of employee input in selecting engineering and work practice controls
-Modification of definitions relating to engineering controls
-New record keeping requirements
Sharps Injury Log must contain, at the minimum:
-The type and brand of device involved in the incident
-The department or work area where the exposure incident occurred
-An explanation of how the incident occured
Is a wrongful act that results in injury to one person by another.
The basis of tort in this case is the unprivileged touching of one person by another. When a procedure is to be performed on a patient, the patient must give consent in full knowledge of the procedure and the risk it entails (informed consent).
Define Invasion of Privacy
This is the release of medical records without the patient's knowledge and permission.
Define Defamation of Character
This consists of injury to another person's reputation, name, or character through spoken (slander) or written (libel) words.
This is the failure to exercise the standard of care that a reasonable person would give under similar circumstances and someone suffers injury because of another's failure to live up to a required duty of care.
The 4 Elements of Negligence:
-Duty: duty of care
-Derelict: breach of duty of care
-Direct cause: legally recognizable injury occurs as a result of the breach of duty of care
-Damage: wrongful activity must have caused the injury or harm that occurred
Define Patient Confidentiality
This is the key concept of HIPAA. All patients have a right to privacy and all information should remain privileged.
Define Informed Consent
This is consent given by the patient who is made aware of any procedure to be performed, its risks, expected outcomes, and alternative.
Biological Hazards - Biological Safety Regulations
-Disinfect the laboratory work area before and after each use when dealing with biologicals
-Never draw a specimen through a pipette by mouth. This technique is not permitted in the laboratory
-Always wear gloves
-Sterilize specimens and any other contaminated materials and/or dispose of them through incineration
-Wash hand thoroughly before and after every procedure
Emergency First Aid
The ability to recognize and react quickly to an emergency may be the difference of life or death for the patient.
Define External Hemorrhage
Controlling the bleeding is most effectively accomplished by elevating the affected part above heart level and applying direct pressure to the wound. Do not attempt to elevate a broken extremity as this could case further damage.
Occurs when there is insufficient return of blood flow to the heart, resulting in inadequate supply of oxygen to all organs and tissues of the body.
Common Shock Symptoms:
-Pale, Cold, Clammy Skin
-Rapid, Weak Pulse
-Increased, Shallow Breathing Rate
-Expressionless Face/Staring Eyes
First Aid For Shock
-Maintain an open airway for the victim
-Call for assistance
-Keep the victim lying down with the head lower than the rest of the body
-Attempt to control bleeding or cause of shock (if known)
-Keep the victim warm until help arrives
Define Cardiopulmonary Resuscitation
Most healthcare institutions require their professionals to be certifies in CPR. It is important for all professional to maintain all certifications acquired.
CPR stands for
Define Urinary Bacteria
Enteric gram-negative bacteria that are always nitrite positive can convert urinary nitrate to nitrite. A positive nitrite test is an indication that a significant number of bacteria are present in the urine.
Define Urinary Leukocytes
The presence of increased numbers of leukocytes or white blood cells in the urine is an indicator of bacteriuria or urinary tract infection (UTI).
Abbreviation for Urinary Tract Infection
Granulocytic leukocytes release:
Esterase when the cells lyse.
Testing for leukocyte esterase by:
The reagent strip method is used in tandem with the microscopic examination of urine sediment for the diagnosis of bacteriuria or UTI.
A positive test by the reagent strip method is indicated by a:
A _____-______ _____-______ urine sample is usually required for any bacterial culture.
clean catch mid stream
Probably the most common specialized urine test is the _____ _____.
Abbreviation for Human Chorionic Gonadotropin
Abbreviation for Uterine Chorionic Gonadotropin
Increased levels of hCG are a natural marker for _____.
Define Hemoccult Fecal Occult Test
Is used to detect hidden blood in stool specimens. The 1st and last portion of the stool after the bowel movement usually contain concentrations of the substances most often required for testing. In order to conduct this test, a Hemmocult developing solution is applied to a stool specimen. Any trace of blue that appears within the specimen is a sign of a positive result.
Define Throat Culture
Are used to detect a bacterial, fungal, or ciral infection in the throat. In order to conduct this test, the patient should be placed in a comfortable lying or sitting position. After the patient have been asked to open their mouth, the MA should depress the patient's tongue then vigorously swab the throat with a sterile swab. After the specimen is collected, it should correctly labeled with the patient's information.
Define Sputum Specimen
Is used to determine the presence of pathogens in a patient's respiratory passage. When obtaining the specimen the MA should instruct the patient to cough deeply, using the abdominal muscles as well as the accessory muscles to bring up secretions from the lungs as well as the upper airways. After the specimen is collected, it should correctly labeled with the patient's information.
Order of Draw for Capillary Specimens
1. Lavender Tube
2. Tubes with other additives
3. Tubes without additives
This test is ordered for infants to detect phenylketonuria, a genetic disease that causes mental retardation and brain damage. Test is done on blood from newborn's heel or on urine.
Order of Draw (BeCause Better Specimens Generate Perfect Goals)
1. Blood Cultures
2. Light Blue Top Tubes
3. Serum or non-additive tube (Red or Red/Gray Top Tubes)
4. Green Top Tubes
5. Lavendar Top Tubes
6. Gray Top Tubes
Define Infection Control/Chain of Infection
Based on the fact that the transmission of infectious disease will be prevented or stopped when any level in the chain is broken or interrupted.
Are infectious , microorganisms that can be classified into groups namely: viruses, bacteria, fungi, and parasites.
Define Portal of Exit
The method by which an infectious agent leaves it reservoir.
Define Standard Precautions and Transmission-Based Precautions
Are controlled measures aimed at preventing the spread of the disease as infectious agents exit the reservoir.
Define Mode Transmission
Specific ways in which microorganism travel from the reservoir to the susceptible host.
5 Main Types of Mode Transmission:
-Contact: direct and indirect
Define Portal Of Entry
Allows the infectious agent access to the susceptible host.
Common Entry Sites:
- Mucous Membranes
-Body systems exposed to the external environment such as the respiratory, gastrointestinal, and reproductive.
What methods are used to limit the transmission of infectious agents:
Define Susceptible Host
The infectious agent enters a person who is not resistant or immune. Control at this level is directed towards the identification of the patients at risk, treat their underlying condition for susceptibility, or isolate them from the reservoir.
Define Medical Asepsis
The destruction of pathogenic microorganisms after them leave the body. It also involves environmental hygiene measures such as equipment cleaning and disinfection procedures.
This procedure used in medical asepsis using various chemicals that can be used to destroy many pathogenic microorganisms. Since chemicals can irritate skin and mucous membranes, they are only used on inanimate objects.
Boiling water at what temperature is considered a form of disinfected:
What is the ratio of bleach and water is a disinfected:
Define Surgical Asepsis
All microbial life, pathogens, pathogens and non-pathogens, are destroyed before an invasive procedure is performed. Often used interchangeably.
4 Methods of Sterilization
-Dry Heat Sterilization
Define Gas Sterilization
Often used for wheelchairs and hospital beds. Useful in hospitals, but costly for the office.
Define Dry Heat Sterilization
Requires higher temperature that steam sterilization but longer exposure times. Used for instruments that easily corrodes.
Define Chemical Sterilization
Uses the same chemical used for chemical disinfection, but the exposure time is longer.
Define Steam Sterilization
Uses steam under pressure to obtain high temperature of 250-254F with exposure times of 20-40 minutes depending on the item being sterilized.
Define Hand Washing
Is the most important means of preventing the spread of infections.
A Routine Hand Washing Procedure:
Uses plain soap to remove soil and transient bacteria.
Hand Antisepsis requires:
The use of antimicrobial soap to remove, kill or inhibit transient microorganisms.
Define Barrier Protection
Protective clothing provides a barrier against infection.
Abbreviation for Personal Protective Equipment
Define Chemical Examination of Urine
This involves the chemical evaluation of the contents of the urine which can be qualitative or quantitative.
Chemical Examination of Urine Involves:
Define Microscopic Examination of the Urine
Is done on urine sediment obtained by certrifugation of 10 to 15ml of urine. The identification and enumeration of the urinary sediment constituents require that only highly skilled and qualified individuals undertake the microscopic examination.
Define Specific Gravity of Urine
Is the ratio of the weight of given volume of urine to the weight of the same volume of distilled water at a constant temperature. This is the most convenient way of measuring the kidney's ability to concentrate and dilute.
During a 24-hour period, normal adults with normal diets and normal fluid intake produce urine with a specific gravity of between _____ and _____.
1.015 and 1.025
The normal range of urine specific gravity for a random collection is _____ to _____.
1.002 to 1.030
Define Urinary pH
Is the reflection of the acidity or alkaline of solution.
The % of hydrogen ion concentration of a solution.
A pH of _____ is considered to be neutral.
A pH of _____ to _____ is considered to be acidic.
0 to 7.0
A pH of _____ to _____ is considered to be alkaline or basic.
7 to 14
Normal, freshly voided urine will usually have a pH of _____ to _____.
4.5 to 8.0
Define Urinary Glucose
Is the sugar typically found in urine.
Is the presence of glucose in the urine.
Define Clean-Catch Specimen
Collecting this sample required special cleaning of the external genitalia.
Define Urine Composition
Urine formed by a healthy kidney is approximately 96% water and 4% dissolved substances consisting mainly of urea, sodium chloride, sulfates and phosphates.
Define Urine Ouput
Is dependent upon the body's state of hydration and normally averages 1200-1500ml every 24 hours.
Decreased urinary output.
Increased urinary output.
Little to no urine output.
Define Routine Urinalysis
Examination of the urine is a diagnostic tool to detect or monitor certain conditions.
3 Parts of Examination of Urine
Physical Examination of Urine
-Assessing the volume of the urine specimen to determine if it is adequate for testing
-Observing the color and appearance (or character) of the specimen noting the odor.
-Measuring the specific gravity.
Define Standard Precautions
This is an infection control method designed to prevent direct contact with blood and other fluids and tissues by using barrier protection and work control practices. All patients are presumed to be infective for blood-borne pathogens.
Standard Precautions are:
-Wear gloves when collecting and handling blood, body fluids, or tissue specimen.
-Wear face shields when there is a danger for splashing on mucous membranes.
-Dispose of all needles and sharp objects in puncture-proof containers without recapping.
Define Transmission-Based Precautions
The 2nd tier of precautions and are to be used when the patient is known or suspected to being infected with contagious disease.
Define Contact Precautions
Are designed to reduce the risk of transmission of microorganisms by direct or indirect contact.
Define Direct Contact Transmission
Involves skin-to-skin contact and physical transfer of microorganisms to a susceptible host from an infected or colonized person.
Define Indirect-Contact Transmission
Involves contact with a contaminated intermediate object in the patient's environment.
Define Airborne Precautions
Are designed to reduce the risk of airborne transmission of infectious agents. Microorganisms carried in this manner can be dispersed widely by air currents and may become inhaled by or deposited on a susceptible host within the same room or over a longer distance from the source patient.
Define Droplet Precautions
Are designed to reduce the risk of droplet transmission of infectious agents.
Droplet Transmission involves:
Contact with the conjunctive of the mucous membrane of the nose or mouth of a susceptible person with large particle droplets generated from the source person primarily during coughing, sneezing or talking.
Define Latex Sensitivity
Is an emerging and important problem in the health care field.
Symptoms/Signs of Irritant Contact Dermatitis
Scaling, drying, cracking of skin,
Symptoms/Signs of Allergic Contact Dermatitis
Blistering, itching, crusting (similar to poison ivy reaction).
Symptoms/Signs of NRL Allergy IgE/histamine mediated
Hives in area of contact with NRL.
Cause of Irritant Contact Dermatitis
Direct skin irritation by gloves, powder, soaps/detergents, incomplete hand drying.
Cause of Allergic Contact Dermatitis
Accelerators processing chemicals.
Cause of NRL Allergy IgE/histamine mediated
NRL proteins; direct contact with or breathing NRL proteins, including glove powder containing proteins, from powdered gloves or the environment.
Prevention/Management for Irritant Contact Dermatitis
Obtain medical diagnosis, avoid irritant product, consider use of cotton glove liners, consider alternative gloves/products.
Prevention/Management for Allergic Contact Dermatitis
Obtain medical diagnosis, identify chemical. Consider use of glove liners such as cotton. Use alternative glove material without chemical. Assure glove material is suitable for intended use (proper barrier).
Prevention/Management for NRL Allergy IgE/histamine mediated
Obtain medical diagnosis, allergy consultation, subsitute non-NRL, gloves for affected worker and other non-NRL products. Eliminate exposure to glove powder - use of reduce protein, powder free gloves for coworkers. Clean NRL-containing powder from environment. Consider NRL, safe enviroment.
From the Latin per os, or "by mouth" or "orally"
From the Latin per rectum, or "by way of the rectum," by suppository
sublingual (under the tongue)
intramuscular (in the muscle)
short for subcutaneous (meaning under the skin)
Every Day, from the Latin quaque die
Twice a Day, from the Latin his in die
Three Times a Day, from the Latin ter in die
Four Times a Day, from the Latin quater in die
After meals or not on an empty stomach, from the Latin post cibum
Each night, from the Latin quaque hora somni, or "at bedtime"
As needed, from the Latin pro re nata, "as circumstances may require"
The hear is:
A hollow muscular organ located in the thoracic cavity between the lungs in a space called Mediastenum.
The heart _____ is located at the level of the 2nd intercostal.
The tip of the heart (_____) is located at the level of 5th intercostal and mid-clavicular line on the left.
The innermost layer of the heart. It is a thin layer of epithelium very similar to vessels' endothelium, which covers the inside part of the heart. It forms the lining and folds back onto itself to form the heart valves and also covers the papillary muscles that anchor chordae tendinae, strings of connective tissue that keep in place the AV valves.
The function of the Endocardium is:
To prevent blood cell destruction and clotting.
The Endocardium is:
Also the layer in which the heart's conduction system is embedded.
The middle and contractile layer of the heart.
The Myocardium is made up of:
Special striated muscle fibers with strong connection with each other (intercalated disks) and branches that ensure a unified and simultaneous contraction of all muscle fibers. There is a high concentration of calcium ions in the space between the muscle fibers (interstitial space), which influences the force of the muscle contraction.
Define "Heart Skeleton"
Is made up of four rings of thick connective tissue. These rings which surround the base of the heart and large vessels, create the cardiac septum, and provide a solid connection between the heart chambers and a strong attachment for the heart valves.
The outermost layer of the heart. Attached with ligaments to the spinal column and diaphragm fixing the heart in its position. Built by two layers of connective tissue.
The outer layer of the Pericardium is called:
The inner layer of the Pericardium is called:
Visceral Pericardium or Epicardium
The two layers of Pericardium are separated by:
A thin layer of fluid to prevent friction. These layers and the fluid between them are referred to as the pericardial sac.
A structure in the middle of the heart called the _____, divided the heart into two sides.
The right side of the heart pumps _____ blood with low pressure from the veins into the lungs (pulmonary circulation).
The left side of the heart pumps _____ blood with high pressure (blood pressure) toward the tissues through arteries (systemic circulations).
The four chambers of the heart:
Define Right Atrium
Receives deoxygenated blood returning to the heart from the body via the superior vena cava which carries blood from the upper body and the inferior vena cava which carries blood from the lower body. Receives blood from the coronary sinus; the largest vein that drains the heart muscle's deoxygenated blood.
Define Right Ventricle
Receives deoxygenated blood from the right atrium which it pumps to the lungs for oxygenation through the pulmonary trunk and then to the pulmonary arteries.
Define The Pulmonary Arteries
Are the only arteries in the body that carry deoxygenated blood (because they are going away from the heart).
Define the Left Atrium
Receives oxygenated blood returning from the lungs via the right and left pulmonary veins.
Define The Pulmonary Veins
The only veins in the body that carry oxygenated blood (because they are going towards the heart).
Define Left Ventricle
Receives the oxygenated blood from the left atrium and pumps it to the body through the aorta, the largest artery of the body.
The Heart Valves Purpose
Is to prevent back flow of the blood thereby assuring uni-directional flow thru the heart.
The Atrioventricular Valves (AV) are located:
Between the atria and ventricles.
AV Cusped Valves Characteristics are:
-They have tough fibrous rings.
-Long and strong leaflets (cuspids).
-They have accessory organs, such as papillary muscles and chordea tendinae.
Define Tricuspid Valve
Is located between the right atrium and the right ventricle. As the name connotes, it has three cusps (or leaflets).
Define Bicuspid Mitral Valve
Is located between the left atrium and the left ventricle. It has two cusps (or leaflets) and it also called the mitral valve.
Define Semilunar Valves
They have half-moon shaped leaflets.
Semilunar Valves Characteristics
-Shallow in depth
-They have no accessory organs
Define Pulmonic Valve
Located between the right ventricle and the pulmonary trunk.
Define Aortic Valve
Located between the left ventricle and aorta.
Is the period of contractions of both Arial and Ventricles.
Is the period of relaxation and filling of all cardiac chambers.
The right and left _____ _____ are the first branches coming out of Aorta and supply the heart with oxygenated blood. The blood runs through there arteries during diastole. Located on the epicardium.
The left coronary artery has two branches:
-Left Anterior Descending (LAD)
-Left Circumflex (LCX)
There is only one main artery that supplies the right side of the heart:
Right Coronary Artery (RCA)
Define Heart Sounds
Are caused by the closure of the heart valves.
S1 First Heart Sound (Lubb)
Occurs during ventricle contraction and the closure of AV valves.
S2 Second Heart Sound (Dupp)
Occurs during ventricular relaxation when SL valves (Pulmonary and Aortic valves) close.
Are caused by diseases of the valves or other structural abnormalities.
Define Heart Rate
Is the number of heart contractions per minute.
The normal heart rate is _____ to _____ bpm.
60 to 100
Abbreviation for Beats Per Minute
Abbreviation for Heart Rate
Heart rate is controlled by _____ and _____ located in Aortic Arch and Carotid arteries.
Chemo-receptors (chemical sensors) and Baro-Receptors (pressure receptors)
The heart is under the influence by the autonomic nervous system (ANS) which is subdivided into the _____ and _____ nervous systems.
Sympathetic and Parasympathetic
Parasympathetic (Vagus Nerve)
Generally has an inhibitory effect via the neurotransmitter.
Acetylcholine may cause what to happen:
-Slow SA pacemarker and HR
-Slow the conduction of electricity in AV node
-Decreased the strength of atrial and ventricular contraction
Sympathetitc via the neurotransmitter Norepinehrine results:
-Increases the HR
-Increases the force of contraction
-Increase the blood pressure
-Via dopaminergic receptors increase the diameter of the visceral blood vessels and consequently visceral blood flow
Define Heart as a Pump
The blood volume ejected outside the heart is equal to the blood volume returning back 1 into the heart.
Define Stroke Volume (Preload)
Is the blood volume ejected outside the ventricle after each contraction.
The Stroke Volume Depends on:
-The volume of blood returning into the heart
-The force of the myocardium contraction
-Vascular resistance (After Load)
The greater the volume of blood inside the heart during diastole, the stronger the heart contraction force during the systole.
Define Cardiac Ouput
The amount of blood ejected outside the heart per minute.
Cadiac Output Formula
Stroke Volume x HR per/min
Peripheral Vascular Resistance
Is the force exerted against the blood flow and is determined by the diameter of the vessel. The lower the vascular resistance the less force is needed to eject the blood out of the heart during systole.
Blood Pressure Formula
Cardiac Output x Vascular Resistance
Graphical presentation of heart electricity (voltage) over time. This electricity is created by specialized cells called pacemaker cells. These cells generate electrical impulses spontaneously (without outside influence) and rhythmically (automatically).
4 Cardiac Cell Properties
The ability to spontaneously trigger electrical impulses without being stimulated by another source.
(also called irritability) the ability to respond and react to a stimulus.
The ability to receive and transmit electrical impulses to adjacent cells.
A myocardial cell's ability to shorten (or contract) in response to a stimulus.
Occurs when positively charged ions (such as sodium and calcium) rapidly move from outside the myocardial cell membrane to the inside, changing the overall charge from negative to a positive.
Occurs immediately after depolarization and is the movement of positively charged ions back to the outside of the cell, returning the cell back to its original polarized state. A cell must repolarize before it can depolarize again.
Absolute Refractory Period
Is the 1st phase of repolarization in which a myocardial cell is unable to react to any electrical stimulus.
Relative Refractory Period
Is the 2nd phase of repolarization during which time a strong enough electrical stimulus might cause new depolarization and contraction.
Conduction System of The Heart
Generates and delivers (conducts) the electricity to all the muscle fibers of the heart resulting in a smooth, complete contraction of the cardiac muscle fibers, which forcefully ejects the blood outside the heart.
Found in the upper posterior portion of the right atrial wall just below the opening of the superior vena cava. It is the primary pacemaker of the heart and has a normal firing rate of 60-100 bpm.
Define Internodal Pathways
Consists of anterior, middle and posterior division that distribute electrical impulses generated by the SA node throughout the right and left atria to the atrio-ventricular (AV) node.
Define AV Junction (AV node)
This node is located at the posterior septal wall of the right atrium just above the tricuspid valve. There is normally a .12-.20 second delay of electrical activity at this level to allow blood to flow from the atria and fill the ventricles with blood.
Bundle of His
Found at the superior portion of the interventricular septum, it is the pathway that leads out of the AV node and connects to the Bundle Branches.
Located at the interventricular septum, the Bundle His divides into the right and left bundle branches, the function of which is to conduct the electrical impulse to the Purkinje fibers throughout the ventricles,
Found within the ventricular endocardium, it consists of a network of small conduction fibers that deliver the electrical impulses from the Bundle Branches to the ventricular myocardium.
EKG is a _____ that measures the heart electricity traveling through the conductive system and an important tool for patient's diagnosis.
-Monitoring patient's HR
-Evaluates injuries to the heart muscle
-Evaluates the pacemakers and conductive system function
-Evaluate the response toward medication
-Provides a baseline record for medical procedure
Is a paper, plastic or metal sensor placed on the patient's skin on a specific location and transmit it to the cable.
Is a wire that connects the electrode to the EKG machine (cardiac monitor).
Is a recorded tracing of the heart electricity from one or two electrodes that provides a specific view of the heart.
Standard Bipolar Limb Leads
Record electrical activity in the frontal plane. Electrodes are applied to the left arm (LA), the right arm (RA) and the left leg (LL). These leads record the difference in electricity between two electrode.
The left arm is positive and the right arm is negative. (LA-RA)
The left leg is positive and the right arm is negative. (LL-RA)
The left leg is positive and the left are is negative. (LL-LA)
Define Augmented Unipolar
Also records electrical activity in the frontal plane.
Define Augmented Unipolar Leads
Record the heart electricity from one limb and compare it with a zero voltage lead in the center of the heart.
AV stands for
R stands for
Right Arm (RA)
L stands for
Left Arm (LA)
F stands for
Left Leg (LL)
The right arm is positive and the other limbs are negative.
The left arm is positive and the other limbs are negative.
The left leg (or foot) is positive and the other limbs are negative.
Precordial Chest Unipolar Leads
All these electrodes are positive and record the heart electricity in the horizontal plane. They include leads: V1, V2, V3, V4, V5, and V6.
Fourth intercostal space, right sternal border.
Fourth intercostal space, left sternal border.
Equidistant between V2 and V4.
Fifth intercostal space, left midclavicular line.
Fifth intercostal space, anterior axillary line.
Fifth intercostal space, midaxillary line.
The Electrocardiographic Grid and Waves
The EKG paper is a graph paper with horizontal and vertical lines at 1-mm intervals. A heavy line appears every 5mm.
The horizontal axis represents time:
1mm = 0.04 seconds
5mm = 0.2 seconds
The vertical axis represents:
voltage, measures in millivolts (1/1000 part of a volt) but expressed in millimeters: 0.1mV-1mm.
The tracing is marked on the paper by a stylus using _____.
The running speed of an EKG machine is _____.
The EKG machine must be properly standardized so that 1mV will produce a deflection of _____.
Refers to movement away from the isoelectric line either upward (positive) deflection or downward (negative) deflection.
Line between two waveforms.
Waveform plus a segment.
Is the first deflection after the diastole, produced by atrial depolarization. It is smooth, round, not more than 2.5mm high and no more than 0.11 sec. Positive in I, II, and V2 to V6.
QRS Complex, Q (q) Wave, R (r) Wave, S (s) Wave
-Represents ventricular depolarization (activation)
-The ventricle is depolarized from the endocardium to the myocardium, to the epicardium
-Normal duration is no more than 0.1 sec (otherwise stated as "less than .12 sec)
Q (q) Wave
The initial negative deflection produced by ventricular depolarization.
R (r) Wave
The first positive deflection produced by ventricular depolarization.
S (s) Wave
The first negative deflection produced by the ventricular depolarization that follows the first positive deflection, (R) wave.
T Wave and U Wave
The first wave after the QRS complex has the following characteristics:
-The deflection produced by ventricular repolarization
-It is slightly asymmetric
-No more than 5mm in height
Is the deflection seen following the T wave but preceding the diastole.
-Represents repolarization of Purkinje fibers
-Round and symmetric less than 1.5mm in height
-A prominent U wave is due to hypokalemia (low potassium, blood level)
This segment is measured from the end of the P wave to the beginning of the QRS Complex.
This segment represents the time of ventricular contraction and the beginning of repolarization of both ventricles. It is measured from end of QRS to the beginning of the T wave.
From J point to the onset of the T wave.This segment is compared to the PR segment to help identify myocardial ischemia or injury.
Is defined as P wave and PR segment and is measured from the beginning of P wave to the beginning of QRS complex. The normal interval is 0.12-0.2 sec.
It represents the total ventricular activity (ventricular depolarization PLUS ventricular repolarization), and it is measured from the beginning of QRS to the end of T wave. The normal duration of this interval depends on the age and the HR.
It is important to determine the HR and its regularity.
This is the interval between two R waves.
J (RST) Junction
Point at which QRS complex ends and ST segment begins.
Assesses the HR
-6 second Method
-Large Boxes Method
Analyzing the EKG Strip
-Assesses the HR
-Identify and examine the P waves
-Assess interval (PR, QRS,QT)
-Evaluate ST segments and T waves
-General Evaluation and Conclusion
6 second Method
The number of QRS Complexes between 6 sec marks on the EKG paper is multiplied by 10. Used generally for estimating slow or irregular rhythms.
Large Boxes Method
Count the number of large boxes between two consecutive RR (one RR interval) and divide into 300 for the ventricular rate; and count large boxes between two consecutive P waves for the atrial rate. Used mainly in regular rhythms.
One minute have 1500 small boxes (0.04 sec). Count the number of small boxes between an RR interval and divide into 1500. This method is more accurate and is used for regular rhythms only.
Select the R that falls on a dark vertical line. Number the next consecutive dark line as 300, 150, 100, 75, 60, and 50. Note where the next R wave falls in relation to the dark lines. That is the heart rate.
The HR is considered regular is all the RR or PP intervals on the EKG leads are equal. If there are changes in their durations the rhythm is irregular.
Identify and examine the P waves
PP interval and measure the size of the P wave in different leads.
Assess interval (PR, QRS,QT)
Measure each of these intervals and determine if they are normal.
Evaluate ST segments and T waves
ST segment elevation or depression and/or T wave abnormalities can suggest the presence of myocardial ischemia or injury.
General Evaluation and Conclusion
Notify the doctor for any abnormality that you can find on the EKG strip.
Arrhyythmias of Sinus Origin
Where electrical flow follows the usual conduction pathway but is too fast, too slow, or irregular.
Normal Sinus rate is
60-100 beats per minutes
If the sinus rate goes beyond 100 per minute, it is called _____.
If the sinus rate goes below 60 per minute, it is referred to as _____.
Electrical impulses originate from somewhere else other than the sinus node.
Electrical impulses go down the usual pathway but encounter blocks and delays.
The electrical impulses bypass the normal pathway and, instead, go down an accessory shortcut.
Normal Sinus Rhythm
The rhythm originated from the SA has the following characteristics:
-HR 60-100 bpm
-Similar P in all the leads in front of all QRS (0.1 sec)
-A constant PR (0.12 to 0.2) sec interval in all the leads, regular rhythm
-HR less than 60 bpm
-Normal equal P and QRS in all the leads, as well as normal PR intervals
-Diastolic pause is longer (main graphic characteristic)
-Bradycardia decreases the blood flow in the brain and other body tissues
-HR over 100 bpm
-Normal equal P and QRS in all the leads, as well as normal PR intervals
-Diastolic pause is very small or nonexistent (main graphic Characteristic)
-Tachycardia reduces the blood supply to the cardiac muscle
-HR 60 to 100 bpm
-Normal equal P and QRS in all leads, as well as normal PR intervals
-Different diastolic pause after each systole. If there are changes with the respiration is names.
Normal Sinus Rhythm (Picture)
Sinus Bradycardia (Picture)
Sinus Tachycardia (Picture)
Sinus Arrhythmia (Picture)
Supraventricular Tachycardias (Picture)
Atrial Tachycardia (AT)
It is cause by an irritable focus in the atria that fires electrical impulses after the normal firing of the SA node pacemaker.
HR is regular between 100 and 150 bpm.
AV Reentry Tachycardia
Is caused when the electrical impulse passes through a passage other than AV node. Cardiac rhythm is regular but up to 250 bpm.
It is an emergency. Notify the Doctor.
Atrial Flutter (Picture)
Is characterized by rapid depolarization of a single atrial focus at a rate of 250-350 bpm.
-b/c the AV node cannot transmit every impulse at excessive rates, there is typically a slower ventricular rate (often appearing at a 2:1, 3:1, 4:1, etc, conduction ratio).
It is an emergency. Notify the Doctor.
Atrial Fibrillation (Picture)
Is caused by multiple irritable sites all over the atria firing at a rate exceeding 350 bpm. These rapid impulses case quivering (fibrillation) of the muscular fibers, which results in a drastic decrease in the cardiac output, blood stagnation and the formation of a clot.
It is an emergency. Notify the Doctor.
Premature Ventricular Complex (PVC) (Picture)
Premature Ventricular Complex (PVC)
A premature ventricular complex arises from an irritable site within the ventricles.
-The ORS is typically greater than 0.12 sec because the ventricular depolarization is abnormal or aberrant
-T wave are usually in opposite direction of the QRS complex
-A full compensatory pause usually follows
Ventricular Tachycardia (VT) (Picture)
Ventricular Tachycardia (VT)
Is characterized by 3 or more PVC's in a row at rate over 100 bpm.
-Regular fast rhythm, 100 to 250 bpm
- No P waves
-Wide, bizarre QRS complexes with T waves pointing in opposite direction from main QRS direction
Ventricular Fibrillation (VF) (Picture)
Ventricular Fibrillation (VF)
It is produced by multiple electrical sites firing electrial impulses at the same time resulting in quivering of the ventricles myocardial muscle fibers, but not a uniform contraction.
It is an emergency. Notify the Doctor.
Asystole (cardiac Arrest, Standstill)
It is a total absence of ventricular electrical activity.
It is an emergency. Notify the Doctor.
Atrio-Ventricular Blocks (AV Blocks)
Defined as a delay or interruption of the electric impulse conduction beyond the AV node. It is evaluated by measuring the PR interval in EKG traces. The PR interval is the key of differentiation and classification of the AV blocks.
Type 1 First Degree AV Block (Picture)
Type 1 First Degree AV Block
It is characterized by a delay of impulses at the level of AV Node.
Type II Second Degree AV Block (Picture)
Type II Second Degree AV Block
Some of the atrial impulses, but not all, are blocked at the AV node level. Because SA node fires regular rhythmic impulses, each P wave occurs in a regular interval across the EKG strip, but no all P waves will be followed by a QRS complex.
Type II Second Degree AV Block (Mobitz) (Picture)
Type II Second Degree AV Block (Mobitz)
It is a more serious pathology. Conducted P waves have a constant PR interval; but there are always non-conducted P waves between cardiac cycles, usually producing a "conduction ratio" between atria and ventricles.
Third Degree AV Block
This type of AV block is also called a Complete Heart Block, or CHB, because impulses generated by the SA node are completely blocked before reaching the ventricular muscle fibers. The atria and ventricles beat independently from each other.
Third Degree Block's Characteristics
-Atrial rate is greater than ventricular rate
-P waves are normal, there are no measurable PR intervals
-The atrial rhythm (P waves) is regular;AND the ventricular rhythm is regular (QRS complexes)
-There is no relationship between P waves and QRS complexes
-If the escape rhythm is ventricular, the QRS complexes will be abnormally wide with a slower ventricular rate
Insufficient blood supply to the myocardium. Atherosclerosis of the coronary arteries is the most common cause of the blood supply reduction.
Define Myocardial Infarction MI
Sudden death of the myocardial tissue due to an abrupt cessation of the blood flow. Clotting and total obstruction of a coronary artery are frequently superimposed on an already narrowed vessel from atherosclerosis.
_____ ischemic injury is manifested by ST segment depression in the leads recording in front of the ischemic site.
_____ and _____ injury is manifested by ST segment elevation in the leads recording in front of the lesion.
Subepicardial and Transmural
Myocardial Infarction Characteristics
-Marked ST elevation with hyperacute T waves reflect complete muscular wall damage
-In later stages (sub-acute MI) deep Q waves are seen on the leads facing the lesion manifesting necrosis
-Pathological Q waves and inverted T waves are signs of fibrosis and scar tissue formation
It is an Emergency. Notify The Doctor.
Whats does WHO stand for?
World Health Organization
The World Health Organization criteria for the diagnosis of myocardial infarction are the presence of at least two of:
-Clinical history of ischemic-type of chest discomfort
-Changes on serial EKG tracings
-Rise and fall in serum cardiac markers demonstrating cardiac tissue damage
An unwanted interference or jitter on the EKG recording. This makes the EKG reading difficult or impossible, as well as can lead to a misdiagnosis.
Define Somatic Tremor
It is a jittery pattern caused by the patient's shivering or by shaking wires. Help the patient relax, cover the patient, make sure that the wires are correctly placed, or try the examination two more times. Redo the EKG until the tracing is more readable.
Define Wandering Baseline
Is it when the baseline moves up and down on the EKG paper. It is often caused by lotion or sweat on the skin interfering with the signal transmitted to the machine. Cleaning the site of the electrode and properly placing it resolves the interference.
Cause by improperly grounded electrical equipment that is directly or indirectly in contact with the patient. Cellular phones and pagers may also interfere with the EKG trace. Disconnect and remove all the electric objects from the patient or near by the machine.
Can be caused by a damaged wire or loose electrodes. If the probes are placed properly, the cause is origination from a broken or damaged wire. Use a different EKG machine or replace the wires. Never use a damaged or malfunctioning machine.
Is a noninvasive diagnostic procedure indirectly, the presence and severity of coronary artery disease and the heart muscle lack of blood supply.
Stress test is performed through _____ or _____ while hooked up to an EKG monitor. The limb leads are applied to the torso of the patient rather than on the extremities.
Exercise (by having the patient walk on a treadmill or by pedaling on a bicycle)
Pharmacologically (by administration of medication that causes increase in heart rate)
Exercise Stress Test
This test is performed until at least 85% of the target heart rate is reached or symptoms or EKG changes develop which requires the test to be terminated. Target heart rate is 220 minus patient's age.
Pharmacologic Stress Test
This test is appropriate for patients with physical limitation. Medications such as adenosine, dipyridamole, or dobutamine are given intravenously through an IV line to cause the heart rate to climb to the target level or the same symptoms and EKG changes as the exercise test develop. The test is concluded after 85% of the target heart rate is achieved.
Ambulatory EKG Monitoring
Is mainly, but not only, used for diagnosis of cardiac dysrhythmias (disorders of the heart rhythm). It can also evaluate the heart rate, rhythm and function during daily activities.
This is an ambulatory EKG done to rule out intermittent arrhythmia or ischemia that could be missed on a a routine EKG.
5 electrode are attached to the patient's trunk instead on the arms and leg to prevent muscle artifact.
Typical Electrode Placement for Holter monitoring:
-2 exploring electrodes are placed over bone (to minimize motion artifact) near the V1 (over the 4th or 5th rib to the right of the sternum) and V5 (over the 5th rib at the left midaxillary line)
-2 indifferent electrodes placed over the sternal head
-One ground electrode placed over the 9th or 10th rib at the right midaxillary line
Recording artifacts can result from the following:
-With an analog system
Incomplete tape erasure - this can result in EKG tracings belonging to two different patients confounding both the scanner and the interpreter.
Tape drag within the apparatus - this will result in recording of spuriously rapid cardiac rhythms. A narrowing of all EKG complexes and intervals should give clue to this situation.
Recording artifacts can result from the following:
This may result in varying QRS amplitude
Recording artifacts can result from the following:
Intermittently loose connection in the insertion of the electrodes into the recording apparatus can result in the absence of all EKG signals which may mimic bradycardia-tachycardia syndrome. Clue to this artifact is the attenuated QRST morphology of the complexes beginning and ending the pause in rhythm.
Recording artifacts can result from the following:
-Movement of Electrode
This may occur during scratching the chest near the electrodes and can produce tracings that look like malignant ventricular arrhythmias. However, the underlying rhythm and rate remain undisturbed and should give clue to this artifact.
Common Cardiovascular Agents
Given to all patients with angina (acute severe chest pain). Causes vasodilation and protests the tissues from hypoxia. It can be administered through a cannula or a facial mask.
Acute severe chest pain
Common Cardiovascular Agents
A sympathetic drug used to manage cardiac arrest, because increases heart contractibility.
Common Cardiovascular Agents
Produces an overall increase in heart rate and myocardial contractility, but newer agents have replaced it in most clinical settings.
Common Cardiovascular Agents
This drug is indicated and is used in cases with hypotension. It causes vasoconstriction. It should be used at the lowest dose that produces adequate perfusion of vital organs.
Systolic blood pressure is less than 90 mmHG
Narrowing of the blood vessel.
Common Cardiovascular Agents
-Beta Blockers (Propranolol, Metoprolol, Atenolol, and Esmolol)
Reduce heart rate, blood pressure, myocardial contractility, and myocardial oxygen consumption which make then effective in the treatment of angina pectoria and hypertension.
Propranolol, Metoprolol, Atenolol, and Esmolol
Common Cardiovascular Agents
Is the drug of choice for the suppression of ventricular ectopy (a beat located outside the conductive system) contractions (PVC), including ventricular tachycardia and ventricular flutter.
Is used in the treatment of paroxysmal supraventricular tachycardia (PSVT), effective in terminating more than 90% of episodes of PVST in adults and infants.
Increases the force of cardiac contraction as well as cardiac output. This is a drug with high toxicity, therefore patients require constant monitoring for signs and symptoms of toxicity such as: yellow vision, nausea, vomiting, and drowsiness.
Is the traditional drug of choice for the pain and anxiety associated with acute myocardial infarction. In high doses, may cause respiratory depression. This is a controlled substance.
Is a powerful smooth muscle relaxant effective in relieving angina pectoris. Headache is a common side effect. Hypotension may occur and patients should be instructed to sit or lie down while taking this medication.
The Circulatory System
The function of this system is to deliver oxygen, nutrients, hormones, and enzymes to the cells (exchange is done at the capillary level) and to transport cellular waste sure as carbon dioxide and urea to the organs (lungs and kidneys, respectively) where they can be expelled from the body.
The average adult has _____ to _____ liters of blood.
5 to 6
The blood vessels are:
Aorta, Arteries, Arterioles, Capillaries, Venule, Veins, Superior and Inferior Vena Cavae.
The blood vessels, except for the _____, are composed of 3 layers.
Blood Vessels Layers:
The outer connective tissue layer is called the _____ _____.
Blood Vessels Layers:
The middle smooth muscle layer is called the _____ _____.
Blood Vessels Layers:
The inner endothelial layer is called the _____ _____.
The aorta, arteries, and arterioles carry _____ blood from the heart to the various parts of the body.
The venules, veins and the superior and inferior vena cavae carry _____ blood back to the heart.
The capillaries, composed of a layer of _____ _____, connect the arterioles and venules
The liquid portion of blood is called ______.
The cellular portion of blood is called the _____ _____.
Plasma comprises _____ of the circulating blood and it contains proteins, amino acids, gasses, electrolytes, sugars, hormones, minerals, vitamins, and water (92%).
The formed elements constitute the remaining _____ of the blood. They are erythrocytes (red blood cells), which comprise 99% of the formed elements, the leukocytes (white blood cells) and the thrombocytes (platelets).
All blood cells normally originate from the stem cells in the _____ _____.
-Hemoglobin, the oxygen-carrying protein
The leukocytes function is to provide the body protection against _____.
The normal amount of WBC's (white blood cells) for an adult is _____ to ______ per microliter.
5,000 to 10,000
The 5 types of WBC's:
The most numerous, comprise about 40% to 60% of WBC population. The are phagocytic cells, meaning, they engulf and digest bacteria. Their # increases in bacterial infection, and often, the first one on the scene.
The 2nd most numerous, comprising about 20% to 40% of the WBC population. Their number increases in viral infection, and they play a role in immunity.
Comprising 3% to 8% of the population, they are also the largest WBC's. Their number increases in intracellar infections and tuberculosis.
Represent 1% to 3 % of the WBC population. They are active against antibody-labeled foreign molecules. Their numbers are increased in allergies, skin infections, and parasitic infections.
Account for 0% to 1 % of WBC's in the blood. They carry histamine, which released in allergic reactions.
Is the process by which blood vessels are repaired after injury.
Hemostatis Stage 1: Vascular phase
Injury to a blood vessel causes it to constrict slowing the flow of blood.
Hemostatis Stage 2: Platelet phase
Injury to the endothelial lining causes platelets to adhere to it.
Hemostatis Stage 3: Coagulation phase
This involves a cascade of interactions of coagulation factors that converts the temporary platelet plug to stable fibrin clot.
Hemostatis Stage 4: Fibrinolysis
This is the breakdown and removal of the clot.
The preferred site for venipuncture is the _____ _____ of the upper extremities.
Median Cubital Vein
The vein of choice because it is large and does not tend to move when the needle is inserted.
The 2nd choice. It is usually more difficult to locate and has a tendency to move, however, it is often the only vein that can be palpated in the obese patient.
The 3rd choice. It is the least firmly anchored and located near the brachial artery. If the needle is inserted too deep, this artery may be punctured.
These veins feel hard or cordlike. Can be caused by disease, inflammation, chemotherapy or repeated venipunctures.
These are winding or crooked veins. There veins are susceptible to infections, and since blood flow is impaired, the specimen collected may produce erroneous test results.
Do not draw blood from an arm with _____ _____ running into it.
Supplies for a Venipuncture:
-Laboratory Requisition slip and pen
-Winged Infusion Sets
-Sterile Syringes and Needles
-Needle Disposal Container
-Prepackaged 70% isopropyl alcohol pads are the most commonly used
-For collections that require more stringent infection control such as blood cultures and arterial punctures Povidone-iodine solution is commonly used
-For patients allergic to iodine, chlorhexidine gluconate is used.
Color-coded for specific tests and available in adult and pediatric sizes.
-These are disposable and are used only once both for single-tube draw and multidraw (more than one tube)
-Needle sizes differ both in length and gauge. 1-inch and 1.5 inch long are routinely used
Also called the tube holder. One end has a small opening that connects the needle, and the other end has a wide opening to hold the collection tube.
Winged Infusion Sets
-Used for venipuncture on small veins such as those in the hand. They are also used for venipuncture in the eldery and pediatric patients.
-The most common size is 23 gauge, 1/2 to 3/4 inch long.
Sterile Syringes and Needles
10-20ml syringe is used when the Vacutainer method cannot be used.
-Prevents the venous outflow of blood from the arm causing the veins to bulge thereby making it easier to locate the veins.
-The most common is a latex strip
-Blood pressure cuffs may also be used
An impermeable pad used to protect the patient's clothing and bedding.
To be placed on each tube collected after venipuncture.
Must be always be worn when collecting blood specimen.
Needle Disposal Container
Must be clearly marked puncture-resistant biohazard disposal containers.
The medical assistant uses 3 skills when contacting patients for phlebotomy:
Blood Request forms should include the following:
-Patient's name and age from ID plate or wristband
-Date and time the specimen is obtained
-Name or initials of person who obtains the specimen
-Department for which work is being done
-Other useful info.
Some test such as those for glucose, cholesterol, and triglycerides require that the patient abstain from eating for at least 12 hours.
Is the accumulation of fluid in the tissues. Collection from edematous tissue alters test results.
Is the permanent surgical connection between an artery and a vein. Are used for dialysis procedures and must never be used for venipuncture's due to the possibility of infection.
Common causes of Failure to Obtain Blood:
-The tube has lost its vacuum
-Improperly positioned needle.
The most common complication of phlebotomy procedure.
The increase in proportion of formed elements to plasma caused by the tourniquet being left too long.
Inflammation of a vein as a result of repeated venipuncture on that vein.
These are 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.
This is a blood clot usually a consequence of insufficient pressure applied after the withdrawal of the needle.
Inflammation of a vein with formation of a clot.
This is a systemic infection associated with the presence of pathogenic organism introduced during a venipuncture.
This is an injury to underlying tissues caused by probing of the needle.
Two-Hour Postprandial Test
This is used to evaluate diabetes mellitus. Fasting glucose level is compared with the level 2 hours after eating a full meal or ingesting a measured amount of glucose.
Oral Glucose Tolerance Test (OGTT)
This test is used to diagnose diabetes mellitus and evaluate patients with frequent low blood sugar.
This requires collection of blood while the patient is in the basal state, that is, the patient has fasted and refrained for strenuous exercise for 12 hours prior to the drawing.
-To determine blood levels of medications
-To monitor changes in a patients conditions
-to measure blood levels of substances exhibiting diurnal variation
Therapeutic Drug Monitoring
This test is used to monitor the blood levels of certain medication to ensure patient safety and also maintain a plasma level.
Blood Cultures (BC)
They are ordered to detect presence of microorganisms in the patient's blood. Usually ordered STAT or as a timed specimen.
Are antibodies produced in response to Mycoplasma pneumoniae infection (atypical pneumonia). The antibodies formed may attach to red blood cells at temperatures below body temperature, and as such, the specimen must be kept warm until the serum is separated from the cells.
Some tests require that the specimen collected by chilled immediately after collection in crushed ice or ice and water mixture.
Some of the tests that require chilled specimen are:
-Arterial Blood Gases
Specimens are protected from light by wrapping the tubes in aluminum foil immediately after they are drawn.
Exposure to light could alter the test results for:
-Vitamins A & B6
Dermal Punctures (Microcapillary Collection)
May be done on both pediatric and adult patients.
Dermal Punctures (Infants)
The heel is used. Areas recommended are the medical and lateral areas of the plantar surface of the foot.
Precautions when performing a dermal puncture:
-Do not puncture deeper than 2.0mm
-Do not perform dermal punctures on previous puncture sites
-Do not use the back of the heel or arch of the foot
-Use the medial and lateral areas of the plantar surface of the heel
Dermal Punctures (Older children and adults)
The distal segment of the 3rd or 4th finger of the non-dominant hand is recommended site.
Lavender Top Tube
Contains the anticoagulant ethylenediaminetetraacetic acid (EDTA). EDTA inhibits coagulation by binding to calcium present in the specimen. The tubes must be filled at least two-third full and inverted eight times.
Lavender Top Tube Common Test:
CBC (Complete Blood Count) Included: RBC count, WBC count and Platelet count; WBC differential count; Hemoglobin and Hematocrit determinations; ESR (Erythrocyte Sedimentation Rate); Sickle Cell Screening.
Light-Blue Top Tube
Contains the anticoagulant Sodium Citrate, which also prevents coagulation by binding to calcium in the specimen. The tube must be filled completely to maintain the ratio of nine parts blood to one part sodium citrate, and should be inverted 3 to 4 times.
Light-Blue Top Tube Common Test
Coagulation Studies-Prothrombin Time (PT)-evaluates the extrinsic; system of the coagulation cascade and monitors; Coumadin therapy; Activated Partial Thromboplastin Time (APTT, PTT) - Evaluates the intrinsic system of the coagulation cascade and monitors Heparin therapy. Fibrinogen Degradation Products (FDP) Thrombin Time (TT); Factor assays, Bleeding Time (BT)
Green Top Tube
Contains the anticoagulant Heparin combined with sodium, lithium, or ammonium ion. Heparin works by inhibiting thrombin in the coagulation cascade. It is not used for hematology because heparin interferes with the Wright's stained blood smear. This tube should be inverted eight times.
Green Top Tube Common Test
Chemistry test: performed on plasma such as Ammonia, carboxyhemoglobin & STAT electrolytes.
Gray Top Tube
Contains additives and anticoagulants. Contains glucose preservative (antiglycolytic agent): sodium fluoride - preserves glucose for 3 days; or lithium iodoacetate-preserves glucose for 24 hours.
Gray Top Tube Common Test
Fasting blood sugar (FBS); Glucose tolerance test (GTT); Blood alcohol levels; Lactic acid measurement.
Red/Gray (Speckled) Top Tube
Contain clot activators: glass particles, silica and celite which hastens clot formation, and thixotropic gel, a serum separator which when centrifuged forms a barrier between the serum and the cells preventing contamination of the serum with cellular elements.
Red/Gray (Speckled) Top Tube Common Test
Most Chemistry Test
Red Top Tube
Contains no additive or anticoagulant. Collected blood clots by normal coagulation process in 30-60 minutes. This is no need to invert the tube after collection.
Red Top Tube Common Test
Serum chemistry test: Serology test; blood bank (glass only)
Yellow Top Tube (sterile)
Contains the anticoagulant sodium polyanetholesulfonate (SPS). These are used to collect specimens to be cultured for the presence of microorganisms.
Define Quality Control (QC)
Purpose of a quality control program is to provide reliable data about the patient's health status by ensuring the accuracy of test results while detecting and elimination errors.
Analyzes chemical components of blood such as hemoglobin and serum, urine and cerebrospinal fluid, based on the differences in electrical charge.
Analyzes plasma levels of drugs and poisons.
This section uses techniques such as radio immunoassay and enzyme immunoassay to detect and mausure substances such as hormones, enzymes and drugs.
The study of bacteria.
The study of parasites.
The study of fungi.
The study of viruses.
ABO Blood Group System (4)
-Group A blood has "A" antigen
-Group B has a "B" antigen
-Group AB has both "A" and "B" antigens
-Group O has neither "A" nor "B" antigen on the cell membrane
Rh Blood Group System
The presence or absence of the "D" antigen on the RBC membrane determines whether a person is RH positive of negative.
One of the most commonly used instruments in the medical laboratory.
Low Power Objective (16mm, 10X)
This allows the item being viewed to be magnified ten times larger than life.
High Power Objective (4-mm, 40X)
By combining the ten-power (10X) ocular lens with the magnification power of forty times life (40X), the magnification vision is increased to four hundred times the normal size.
Oil Immersion Objective (1.8mm, 100X)
This objective enables us to reach a possible total magnification of one thousand times normal life size by multiplying the ocular lens magnification (10X) by one hundred (100X), (10X x 100X = 1000X).
Basic unit of length. Is 39.37 inches long. Often used in laboratory reports, charts, and other data requiring linear measurements.
Is the basic unit of capacity of volume. This measure tells us how much space an item occupies.
Is the basic unit of weight or mass.
Preparing Solution and Dilutions
Desired strength = X(amount needed)
Available strength amount available
Arterial Blood Gas Studies (ABG's)
Are valuable tools in the treatment of critically ill patients; used to monitor critically ill patients.
The Gram Stain
Used to classify bacteria on the basis of their form, size, cellular morphology, and gram stain reaction.
Are bacteria that take up and retain the crystal violet and resist alcohol decolonization. They appear blue to black.
Are bacteria that are decolorized completely by ethanol and take up safranin counterstain. They appear red.
Gram Staining Procedure
-Dye: crystal violet
-Mordant: Gram's iodine
-Decolorizer: 95% ethyl alcohol/acetone mixture
-Counterstain: safranin stain
Will produce a thin monolayer of organisms for easy visualization but will be thick enough to reveal characteristic arrangement of the bacteria.
Smearing and Fixation Technique
Gently roll the swab across the slide, in one direction, leaving a thin film of specimen material on the slide.
The staining procedure involves the sequential application of primary stain mordant, decolorizer, and counter-stain to a bacterial smear.
Staining of Blood Smears
The stain commonly used for examination of blood cells is all polychromatic because they contain dyes that will stain various cell components different colors.
Components of the Urinary System
Two kidneys, two ureters, urinary bladder, and a urethra.
Absence of urine.
The presence of blood in urine.
The passage of large volumes of urine.
The presence of excess proteins in urine.
First Morning Sample
The type of specimen most commonly used for routine urinalysis.
Is one that is collected not at the beginning or end of voiding, but in the middle of urination.
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