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Phlebotomy > Module 3: Patient Preparation > Flashcards

Module 3: Patient Preparation Flashcards

1
Q

what should you do before beginning blood collection procedure

A
  • review lab requisition form
  • identify pt
  • explain procedure
  • obtain pt consent
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2
Q

who is authorized to order lab tests

A
  • physicians
  • physician assistants
  • nurse practitioners
  • chiropractors in some states
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3
Q

info lab requisition form has

A
  • specific tests the provider wants to be completed
  • provider information
  • pt full name
  • pt date of birth
  • pt sex
  • specific identification numbers (medical record number)
  • specific precautions (allergy, sites to avoid)
  • space to document date and time of collection, billing info, and diagnostic coding
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4
Q

what should you review the requisition form for

A
  • any discrepancies
  • duplicate test orders
  • missing info
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5
Q

what to write on tubes after collection

A
  • date and time of collection
  • your initials
  • pt full name and date of birth
  • other specific identifiers
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6
Q

what agency mandates using two pt identifiers

A

The Joint Commission

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7
Q

what to do if pt is unable to state their identifying info

A
  • view pt wristband
  • ask family member to confirm pt identity
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8
Q

deliberately touching pt without their consent

A

battery

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9
Q

informed consent

A
  • pt received full info about procedure
  • form required for high risk, invasive, and surgical procedures
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10
Q

expressed consent

A
  • pt gives explicit consent to procedure orally or in writing on a consent form
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11
Q

implied consent

A
  • pt actions indicate they are giving consent
  • most common for phlebotomy
  • pt extends arm
  • low risk procedures
  • emergency medical situations
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12
Q

consent for minors

A
  • child’s parent or guardian must give consent
  • exceptions for teens who are married, in the military, emancipated by court order, or otherwise self-supporting and independent
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13
Q

does the pt have to offer an explanation for refusing to give consent

A

no

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14
Q

what to do when pt refuses consent

A

obtain written proof of refusal

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15
Q

what to do if pt comes to get blood drawn without adhering to testing requirements

A
  • consult with provider
  • may need to reschedule tests
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16
Q

fasting pretesting preparation

A
  • not each or drink anything other than water
  • typically 8 to 12 hr before test
  • encourage pt to drink water
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17
Q

medication pretesting preparation

A
  • tests may determine the effectiveness of medications
  • pt takes medications at specific time and has specific time for specimen collection
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18
Q

basal state pretesting preparation

A
  • based on pt lifestyle and overall condition
  • after refraining from eating or exercising for 12 hr, typically first thing in the morning
  • necessary when provider establishes reference ranges
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19
Q

things to ask about during pt interview

A
  • allergies to latex or adhesives
  • previous reactions to blood draws (feeling faint, nauseous)
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20
Q

what to do if pt feel faint

A
  • stop procedure
  • pt lower head and take deep breaths
  • loosen tight clothing
  • apply cold compress on forehead or back of neck
  • observe pt for 15 minutes
  • document the incident
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21
Q

what happens when applying a tourniquet to the arm on the side of a mastectomy

A
  • affect lymph nodes
  • swelling, injury, infection
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22
Q

collection site for pt with double mastectomy

A

back of hand

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23
Q

things that are contraindications for a blood draw on that arm

A
  • mastectomy
  • central venous access device
  • arteriovenous fistula
  • IV
  • cast
  • scarring
  • burns
  • thrombosed vein
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24
Q

what do thrombosed veins feel like when palpating

A
  • rope cord
  • easily roll
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25
Q

how does alcohol affect blood

A
  • coagulation activation
  • platelet reactivity
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26
Q

how does smoking affect blood

A
  • elevates coagulation factors
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27
Q

how does exercise affect blood

A
  • coagulation activation
  • pt rest for 15-30 minutes after exercising
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28
Q

how to explain venipuncture

A
  • discuss steps: preparing site, tourniquet, inserting needle, filling tubes
  • inform of slight pain, never promise it won’t hurt
  • tell pt to say something if they feel sick or have severe pain
  • explain complications and what to do if they occur, most are relatively rare
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29
Q

excessive bleeding or bruising phlebotomy complication

A
  • little bleeding and bruising is common
  • bruise bigger than 2x2 gauze
  • bleeding saturates 2x2 gauze
  • apply pressure and ice
  • evaluation by provider
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30
Q

severe pain or lack of sensation phlebotomy complication

A
  • severe pain, numbness, tingling
  • indicates nerve damage
  • if electric shock pain or pain radiating down arm is felt during procedure, stop procedure and apply pressure and ice
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31
Q

infection phlebotomy complication

A
  • area around site becomes red, swollen, and painful
  • hematomas can become infections
  • contact provider
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32
Q

pt positioning for venipuncture

A
  • comfortable position in bed for inpatient settings
  • venipuncture chair
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33
Q

can you perform venipuncture on pt who is standing or sitting on the edge of the exam table

A

no

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34
Q

arm positioning for venipuncture

A
  • full extension of arm
  • palm facing upward
  • slight rotation depending on which vein you are accessing
  • pillow or armrest can improve pt comfort
  • support arm under the elbow with free hand
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35
Q

types of blood vessels

A
  • arteries
  • veins
  • capillaries
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36
Q

three accessible veins in antecubital fossa

A
  • median cubital vein (center)
  • cephalic vein (lateral, thumb side)
  • basilic vein (medial, pinky side)
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37
Q

first choice vein in antecubital fossa and why

A
  • median cubital vein
  • large
  • less prone to injury
  • less painful
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38
Q

second choice vein in antecubital fossa and why

A
  • cephalic vein
  • large
  • may not be easy to see
  • tends to roll
  • difficult to stabilize
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39
Q

third choice vein in antecubital fossa and why

A
  • basilic vein
  • large
  • close to brachial artery
  • close to median nerve
  • don’t readjust needle
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40
Q

fingers used for capillary puncture

A
  • middle or ring finger
  • little finger is too small, close to bone
  • index finger and thumb are usually sensitive
41
Q

where on the finger should you perform capillary puncture

A
  • side of the finger
  • tip is too sensitive, fewer capillaries
42
Q

capillary puncture site for infants under 12 months

A

side of heel

43
Q

hand veins

A
  • next choice after antecubital fossa
  • more fragile
  • often roll
  • smaller
  • tends to be more painful than antecubital area
  • best to use a butterfly needle
44
Q

places you should never collect blood from for venipuncture

A
  • inside of wrist: tendons and nerves close to surface
  • ankle or foot veins without provider approval
45
Q

ankle and foot veins

A
  • last choice for venipuncture
  • difficult to access
  • easy to injure
  • painful
  • never from pt with diabetes or peripheral vascular disease due to poor circulation
  • increase risk of infection, phlebitis, hematoma
46
Q

palpation of vein suitable for venipuncture

A
  • soft
  • flexible
  • bouncy
47
Q

what does pulsation while palpating indicate

A

the vessel is an artery and should not be used

48
Q

what should you palpate a vein for

A
  • depth for angle insertion
  • direction of vessel for needle placement
  • dimension for choosing right needle size
49
Q

how to make veins easier to palpate

A
  • place pt arm below heart level
  • warm compress to dilate veins
50
Q

locations not suitable for venipuncture

A
  • above IV insertion
  • arm with fistula, CVAD
  • arm on same side as mastectomy
  • site with edema, scarring, hematoma
51
Q

sclerotic veins

A
  • not suitable for venipuncture
  • hard, inflexible, narrow
  • as people age
  • difficult to puncture and painful
  • from repeated blood draws
52
Q

tortuous veins

A
  • not suitable for venipuncture
  • varicose veins
  • twisted, dilated, lack elasticity
  • not in straight line
53
Q

thrombotic veins

A
  • not suitable for venipuncture
  • vein with thrombus (blood clot)
  • hard, inflexible
  • tender when touched
54
Q

fragile veins

A
  • not suitable for venipuncture
  • older adults, newborns, pediatric pts
  • thin, weak, difficult to puncture
  • collapse easily
  • do not refill quickly
  • painful
  • multiple sticks to get enough blood
55
Q

phlebitic veins

A
  • not suitable for venipuncture
  • tender, warm, red area around them
  • can have clots
  • difficult to puncture
  • painful
56
Q

how far should lancet puncture on an infant needle stick

A

no deeper than 2 mm

57
Q

one of most common lab test

A

routine urinalysis

58
Q

urinalysis

A
  • exam of pt urine for variety of factors
  • appearance, odor, color, pH, specific gravity, presence or absence of protein/glucose/hemoglobin
59
Q

usual fasting time for urinalysis

A

6 to 12 hr

60
Q

urine culture

A
  • preparing urine for growth and identification of microbes
  • often followed by sensitivity testing
  • specimen must be from clean-catch sample or from catheter
61
Q

random urine specimen

A
  • clean, disposable container
  • label on side on container
  • no preparation needed
  • 30 to 60 mL
  • specimens at home stored in fridge and brought to lab asap
62
Q

fasting (first morning) urine specimen

A
  • same supplies and instructions as random urine
  • collect specimen immediately after waking up
  • more concentrated
  • pregnancy, glucose
  • refrigerate and get to lab asap
63
Q

how long after collection does urine start to deteriorate

A

30 min

64
Q

clean-catch (midstream) urine specimen

A
  • sterile urine container
  • nothing other than urine can come in contact with the inside of the container
  • used to detect bacteria
  • wash hands before and after collection
  • clean genitals
  • urinate a bit in the toilet and then urinate in the container
  • collect until the container is 1/4 to 1/2 full
  • final stream deposited in the toilet
65
Q

timed urine specimen (24 hr)

A
  • container with preservative
  • usually 3000 mL
  • 24 hr collection
  • record start time
  • begin with 2nd void of the day
  • collect all urine
  • container kept in ice or in fridge
66
Q

urine reagent testing

A
  • CLIA waived test
  • visual or physical observation of strip
  • wear clean gloves, dip strip into urine, observe squares for color changes
67
Q

urine pH

A
  • 4.6/5.5 to 8
  • important for bacterial growth
68
Q

what happens if urine is left unrefrigerated for a long time

A
  • becomes more alkaline (higher pH)
  • higher bacteria counts
69
Q

urine specific gravity

A
  • concentration of urine
  • expected range from 1.003 to 1.030
  • usually 1.010 to 1.025
  • below 1.010 is diluted
  • above 1.010 is concentrated
70
Q

urine white blood cells and nitrites

A

indicate infection

71
Q

urine hemoglobin

A

indicates bleeding, infection, cancer, kidney disease, chemical poisoning

72
Q

urine ketones

A
  • products of fat metabolism
  • presence results from diabetes, starvation, vomiting
73
Q

urine bilirubin

A

indicates liver disease or RBC destruction

74
Q

urine protein

A

indicates inflammation, infection, kidney disease, chemical poisoning

75
Q

urine glucose

A

indicates diabetes

76
Q

fecal occult blood test

A
  • identifies blood in stool
  • diagnose GI lesions and colorectal cancers
77
Q

instructions for stool collection

A
  • sterile container
  • defecate directly into a container or into a clean container and transfer to the specimen container
  • avoid getting urine or water in container
  • does not require a large amount of stool
  • do not refrigerate if testing for parasites
  • return to lab immediately
78
Q

preparation instructions for FOBT

A
  • don’t eat red meat, citrus fruits, or raw vegetables for 3 days before collection
  • don’t take vitamin C or aspirin for 3 days before collection
79
Q

sputum

A

material coughed from lungs

80
Q

why would a provider order a sputum test

A
  • testing what microorganism is causing respiratory infection
  • determine if treatment is effective
81
Q

when should you collect the sputum for testing to be most accurate

A
  • morning
  • before eating or drinking
  • more concentrated
82
Q

instructions for sputum collection

A
  • sterile container
  • collect first thing in the morning
  • cough forcefully into container and expectorate
  • don’t spit saliva into container
  • 1-2 teaspoons
  • close lid and label
  • deliver to lab asap
83
Q

why do labs analyze semen

A
  • fertility testing
  • assessing effectiveness of sterilization procedure (vasectomy)
  • criminal investigation
84
Q

pretesting instructions for some semen tests

A

abstain from sexual activity and alcohol several days before collection

85
Q

instructions for semen collection

A
  • clean container, free of chemicals
  • ejaculate into container
  • secure lid and label
  • protect from extreme heat and cold
  • get to lab within 1 hr of collection
86
Q

neutral pH for urine specimen

A

7

87
Q

what to ask if pt seems distracted while you’re explaining a procedure

A

would you like me to repeat the directions

88
Q

do you need verbal or written consent in emergency situations

A

no

89
Q

should you explain test names or reasons tests are being run to a pt

A
  • no
  • provider should
90
Q

is the provider’s license number required on a lab requisition form

A

no

91
Q

pt preparation for cholesterol test

A
  • sit for 5 minutes
  • lowers test results
92
Q

how to cleanse skin for blood culture

A
  • twice
  • once with isopropyl alcohol
  • allow to dry for 60 sec
  • once with chlorhexidine gluconate swab
  • allow to dry for 30 sec
93
Q

accession number

A

specific to specimen not the pt

94
Q

identification in an outpatient facility

A
  • one visual, two verbal
  • picture ID, full name, DOB
95
Q

how does a lipemic specimen appear

A

cloudy

96
Q

collection method for coagulation test on 3 y/o

A

winged safety butterfly

97
Q

who should you verify time of medication administration with

A

nurse

98
Q

what to do if pt has IVs in both arms

A

ask nurse to turn IVs off for 2 mins

99
Q

how long after medication administration should you draw blood for peak level test

A

15 to 30 mins

Phlebotomy (9 decks)

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