exam 2 Flashcards
which would cause to check the per-cordial leads?
the r wave in V3 is higher than V4
if the deflection on an ECG are too small to see clearly, what setting would you change?
increase amplitude to 20mm/mV
if the deflection on an ECG are too big to see clearly, what setting would you change?
decrease amplitude to 5mm/mV
what additive is used when collecting a fluid to test for protein?
heparin
SAF goes to?
goes to microbiology
SPS goes where?
blood cultures
when collecting a set of cultures, aerobic bottle should be collected last? t or f
false
this collection is checked for absence of sperm?
post-vasectomy collection
the muscle cells depolarizing and repolarizing CAN or CANT be detected on an ECG tracing
can
can you collect from an unconscious patient?
yes, as long as a responsible person has identified them
patient extending their arm is considered this type of consent?
implied
where is atrial reporlarization seen on an ECG?
It is hidden in the QRS complex
how can u decrease the pressure exerted on a fragile veins during phleb?
use a syringe
- which percordial lead usually shows the largest R wave?
V5
what is an appropriate reason to collect a discard tube?
when collecting below an IV (after been turned off)
- what is the correct order of collection for microtainers?
LAVENDAR/EDTA always first for microtainer. - lavender, gold
where does peritoneal fluid come from?
around the abdominal organs
the heart is a hollow sac?
true
pericardium
tough protective sac
- 2 layers parietal and visceral
epicardium
outer layer
myocardium
thick middle layer of cardiac muscle
endocardium
inside layer
depolarization
negative charge changes to positive charge
repolarization
positive charge returns back to negative
contraction
blood moves out of chambers
relaxation
blood fills chamber
electrical impulse travels what direction always
right to left
what are the 2 phases of the cardiac cycle
systole and diastole
systole
contraction phase, ventricles eject blood
diastole
relaxation phase, atria contract, ventricles fill
normal heart rate is and how long
72 beats per minute and takes 0.8 seconds
PR segment
the delay of the impulse at the AV node
QRS complex
ventricular depolarization
Q wave is not always seen
atrial repolarization is hidden in the complex
T wave
ventricular repolarization (relaxation)
limb leads I, II, and III are
bipolar
aVR, aVL, and aVF are
unipolar augmented leads
V1-V6 are what type of leads?
precordial and unipolar leads
V1 goes where
4th intercostal space, right of sternum
V2 goes where
4th intercostal space, left of sternum
V3 goes where
on 5th rib (in between 2 and 4)
V4 goes where
5th intercostal space, mid clavicular line
V5 goes where
5th intercostal space, shoulder
in the space not the bone
V6 goes where
5th intercostal space? armpit
R wave progression changes from…
negative in V1 to positive in V6
tallest R wave is seen when the heart current is running parallel to lead axis?
V5 sometimes V4
V6 is often smaller than V?
V5
einthovens triangle
II = I + III
examine the tracing before or after the patient is disconnected?
BEFORE
what to do if lead II is not positive
check limb leads to ensure attached correctly
aVR needs to be positive or negative
negative
if heart rate is >100 beats per minute what do u do?
increase speed to 50mm/s to spread waves out further on tracing
normal sensitivity is
10mm/mV
what angle of insertion do u use for hand collections?
<10 degrees
aerobic bottle
grows bacteria, yeast, or fungi that require oxygen
anaerobic bottle
grows bacteria that require the absence of oxygen
if bacteria multiplies to a fast an infection called what can develop?
bacteremia or septicemia
why are blood cultures collected?
to determine the presence and extent of an infection
in the blood culture bottles are the vacuums calibrated?
no
cerebral spinal fluid?
clear & colourless
cushions the brain and spinal cord
where do u draw CSF
Lumbar puncture (lower back)
CSF done as RT or STAT
STAT
what tubes and order of CSF
received in 3-4 sterile capped tubes
labelled #1-4, order collection
cytology
cell examination
hematology
cell count and differential
microbiology
gram and C&S
chemistry
protein and glucose
amniotic fluid is collected when
12-42 weeks gestation (pregnant)
pleural
fluid around lung
pericardial fluid
fluid builds up within pericardium
reduce cardiac output
peritoneal fluid
fluid in abdominal cavity surrounding organs
paracentesis
the removal of peritoneal effusion by percutaneous
effusion
abnormal accumulations of fluid due to different disease states
steps for capillary collection
wipe away first drop, then, squeeze, release, drop, collect, and twirl
newborn screening is used to diagnose…
17 treatable conditions, including 14 metabolic conditions, 2 endocrine and CF
when is a newborn screening performed
between 24-72 hours after birth
and the TAT IS 48-96 hours
when collecting with an IV in arm how long does it need to be turned off for before u collect?
2 minutes
how many mL need to be discarded when there’s an IV connected
first 5 mL is discarded
hematoma
accumulation of blood under skin
arrhythmias
any cardiac rhythm other than normal sinus rhythm
sinus bradycardia
<60 BPM
caused by delay in firing of the SA node
sinus tachycardia
> 100 BPM
caused by SA node acceleration
asystole
flatline
no electrical activity in the heart
basically dead
what does MI stand for
myocardial infarction
3 components required for diagnosis of MI
-patient history + physical exam
- blood work - troponin
- ECGs
pace maker spikes before the P wave =
atrial placement
pace maker spikes before QRS =
ventricular placement
standard positions for ECG is
supine
if chest sensors need to be moved what do i do?
- skip the lead
- physician may request seniors in diff spot
- always record new position
dextrocardia
patients have their heart residing in their chest
if a patient has dextroxardia the leads may show…
reversed
holter monitor
portable ECG device that takes continuous recordings
phlebotomists are in the patients *** space
intimate
express consent
it’s been signed
implied consent
implying they will let me collect
(giving me their arm for phleb)
empathy
ability to figuratively put yourself in the place of another so you can feel what emotions they are feeling
can an ECG detect heart murmurs?
no
duration
measured in fractions of a second
amplitude
measured in mv
how high is the wave
septal fascicle
depolarizes the interventricular septum in a left to right direction
cardiac vector or vector
the direction of electrical current produced by the patients heart
when cardiac flow/vector is in the SAME directions as the lead axis, there will be a *** deflection?
positive or upward
when the cardiac flow is the exact opposite direction as the axis the deflection will be ??
negative or downward below the baseline
when cardiac current is at an angle to and in same direction as the axis, there will be *** deflection
less strong positive deflection
when the cardiac current is at an angle but in opposite direction as the lead axis the deflection will be?
less strong negative deflection
when the lead axis is perpendicular to cardiac vector the ECG deflection is
biphasic
for most people the overall electrical current direction in the heart is ?
downward and to the left
aVR
center of heart to positive electrode at the RA
aVL
center of heart to positive electrode at the LA
aVF
center of heart to positive electrode at the LL
chest leads view the electrical activity of the heart in what plane?
horizontal
the change in appearance of the R wave is referred to as the
R wave progression
lead II is a ** deflection
positive
patients with burns to chest what to do?
all isolation procedures need to be followed bc the patient is susceptible to infections.
if chest is bandaged a nurse needs to be consulted to take off or not. NEVER the mla
how do u identify a heart attack
ECG
Troponin
history and patient demographics
kinesics
study of non verbal communication or body language
express consent
requires documentation
implied consent
presumed when a patient presents their arm/hand voluntarily
informed consent
indicate the patient has given consent in some way for the procedure
who’s responsibility is to package and label TDG properly
the consignor (sender)
frozen specimens should be transported using?
dry ice or ice packs (NOT regular ice)
lead II should be positive or negative
positive
einthovens law
II = I + III
aVR should be positive or negative
negative
normal paper speed for an ECG is
25mm per second
if the heart rate is fast what do u do?
increase paper speed (to 50mm per second) and it will spread the waves further apart
the normal sensitivity for an ECG is
10mm per mV
the sensitivity may be increased to ** or decreased to **
increased to 20mm per mV or decreased to 5mm per mV
there are 3 components to the diagnosis of a MI (heart attack)
history and physical examination
blood work (troponin)
ECGs
left or right ventricle is usually more dominant in the neonate and young children?
the right ventricle normally
therapeutic drug monitoring can be used to measure?
antibiotic levels
what is a possible consequence of overfilling a tube containing an anticoagulant?
clotting of the specimen
what anticoagulant does not act by chelating calcium?
sodium heparin
