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Study Materials HCLD > Patient Test Management > Flashcards

Patient Test Management Flashcards

1
Q

Define a Chain of Custody.

A

Chain of custody refers to the chronological documentation, and/or paper trail, showing the procurement, custody, control, transfer, analysis, and disposition of the specimen.

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2
Q

What is the purpose of a chain of custody?

A

a chain of custody form is required for any specimen used as legal evidence in court.

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3
Q

CPOE

A

Computerized Provider Order Entry (CPOE)

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4
Q

Computerized Provider Order Entry (CPOE)

A

CPOE is a computerized process for health care providers to electronically enter and order medical procedures and laboratory tests based on a predetermined algorithm.

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5
Q

CPT

A

Current Procedural Terminology

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6
Q

What is the purpose of Current Procedural Terminology (CPT) codes?

A

The purpose of CPT is to provide a uniform language accurately describing medical, surgical, and diagnostic services.

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7
Q

Name two reason that a CPT code might have a modifier.

A
  1. a service or procedure has both a technical and professional component2. a service or procedure was performed by more than one physician and/or in more than one location
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8
Q

What does a -26 CPT code modifier stand for?

A

26 - Professional Component

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9
Q

What does a -59 CPT code modifier stand for?

A

59 - Distinct Procedural Service

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10
Q

What does a -91 CPT code modifier stand for?

A

91 - Repeat Clinical Diagnostic Laboratory Test

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11
Q

Define a reference range.

A

A reference range is a collection of normal values for a constituent of clinical interest.

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12
Q

CFR

A

Code of Federal Regulations

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13
Q

How much blood is present in the average adult male?

A

5 quarts

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14
Q

What is the composition of blood in an average adult male?

A

5 quarts of blood; 3 quarts of plasma and 2 quarts of cells

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15
Q

What are blood cells suspended in in the human body?

A

plasma

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16
Q

What are red blood cells?

A

erythrocytes; delicate, round, biconcave bodies that contain hemoglobin that is used to transport oxygen to the tissue and carbon dioxide to the lungs.

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17
Q

Name 5 ways that hemolysis can occur.

A
  1. improper handling of a blood specimen;2. dilution;3. exposure to contaminants;4. extremes in temperature;5. pathological conditions
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18
Q

How does hemolysis occur?

A

when the thin protective membrane of red blood cells is ruptured and hemoglobin is released into the plasma.

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19
Q

What type of cell in the blood is responsible for hemolysis?

A

red blood cell or erythrocte

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20
Q

What is the primary purpose of white blood cells?

A

Leukocytes fight infection

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21
Q

How would one obtain serum?

A

Serum is obtained from clotted blood that has not been mixed with an anticoagulant. The clotted blood is then centrifuged, yeilding serum.

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22
Q

anticoagulant

A

a chemical that prevents the clotting of blood

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23
Q

What two types of proteins does serum contain?

A

albumin and globulin

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24
Q

What type(s) of tubes can be used to collect serum?

A

marbled red/gray, red-stopper tubes, and/or gold top tubes

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25
Q

How would one collect plasma?

A

Plasma is obtained from blood that has been mixed with an anticoagulant in the collection tube and is therefore not clotted. This tube is then centrifuged to yield plasma.

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26
Q

What three types of proteins are contained in plasma?

A

Albumin, globulin, and fibrinogen

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27
Q

What is the main difference between plasma and serum?

A

Plasma retains fibrinogen

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28
Q

What is similar between plasma and serum?

A

They both contain albumin and globulin

29
Q

What are the four steps involved in obtaining a good quality specimen for diagnostic testing?

A
  1. preparation of the patient;2. collection;3. processing;4. storing and transport
30
Q

What is the most common type of error when comparing the preanalytical phase to the analytical phase?

A

Specimen collection, preparation, and submission

31
Q

List the four most comon errors affecting all types of specimens.

A
  1. mislabeled specimen or failure to provide all pertinant information on the requisition form;2. insufficient quantity of specimen;3. failure to use the correcct container/tube;4. failure to tighten specimen container lids
32
Q

Describe the process for drawing whole blood.

A

Whole blood is drawn into tubes containing an anticoagulant. Once filled the tube must be inverted 8-10 times to ensure adequate mixing and prevent clotting.

33
Q

Is it recommended to split whole blood specimens?

34
Q

What is the consequence of not allowing complete clotting of a serum preparation to happen prior to centrifugation?

A

Failure to allow clotting may result in fibrin clots that interfere with accurate laboratory results.

35
Q

What are the consequences of leaving a serum sample to clot for an extended period of time?

A
  1. increase in enzyme levels;2. increase in potassium;3. decrease in glucose
36
Q

What three pathologic conditions can adversely impact lab results using serum preparations?

A
  1. hemolysis;2. lipemia (lipemic)3. icteric
37
Q

What type of blood-related specimen collection requires no coagulate in the collection tube?

38
Q

What two blood-related specimen collection does require anticoagulants in the collection tube?

A

whole blood and plasma

39
Q

What are the most common erros affecting tests utilizing serum?

A
  1. Failure to tighten specimen container lids (leakage, contaimination);2. Failure to allow specimens to clot before centrifugation;3. hemolysis;4. lipemia (cloudy or milky serum)
40
Q

What affect does lipemia have on a patient’s serum and why?

A

Lipemia causes cloudy or milky serum sometimes due to the patient’s diet.

41
Q

How is plasma obtained?

A

Plasma is obtained by drawing a whole blood specimen and then processing with subsequent centrifugation to separate the plasma. Remember the tube must be inverted 8-10 times to ensure adequate mixing and prevent coagulation.

42
Q

Why is it important to distinguish between serum and plasma?

A

plasma contains clotting factors

43
Q

What are the seven most common errors in the collection and preparation of plasma?

A
  1. failure to collect specimen in the correct additive;2. failure to mix the specimen with additive immediately after collection;3. hemolysis4. incomplete filling of the tube;5. failure to separate plasma from cells within 30-45 minutes of venipuncture for those specimens requiring this step;6. failure to label transport tubes as plasma;7. failure to indicate type of anticoagulant (EDTA or citrate)
44
Q

What color is hemolyzed serum or plasma?

A

Pinkish red, rather than the normal clear straw or pale yellow color

45
Q

What types of analytes are adversely affected by hemolysis and/or prolonged exposure to a clot?

A

glucose, potassium, lactate dehydrogenase (LDH), cholesterol, creatinine, iron, phosphorous, calcium, and most enzymes.

46
Q

Hemolyzed specimens are not suitable for what two specialized types of testing?

A

hematology and coagulation

47
Q

What is one of the most common and expensive errors in specimen collection?

A

submission of an insufficient vollume of specimen for testing

48
Q

Name one instance of patient preparedness that could lead to lipemia.

A

Patients who consume lipid rich foods, such as meats, butter, cream, and cheese, within a 12-16 hour period immediately preceding collection of a blood specimen may have temporarily elevated lipid levels. These may manifest ass cloudy or lipemic serum.

49
Q

What sort of tests can be falsely elevated by lipemia?

A

liver enzyme results (ALT and AST) and CBCs. That is why fasting is important before these sorts of tests are performed.

50
Q

Hematology specimens must be tested within what timeframe from collection?

51
Q

What type of additive tube is used for plasma determinations in chemistry and are good for STAT procedures because they eliminate the need to wait for a clot to form?

A

lithium heparin

52
Q

What type of additive is used for whole blood hematology determinations, immunohematology testing and blood bank testing?

A

K2EDTA and K3EDTA

53
Q

Can whole blood collections be frozen?

A

No, freezing will cause red blood cells to hemolyze

54
Q

According to the NCCLS and the International Council for Standardization in Hematology (ISCH), what is the coagulant of choice in specimen collection and blood cell counting?

55
Q

Name the three reasons why K2EDTA was choosen over K3EDTA as the anticoagulant of choice in specimen collection and blood cell counting.

A
  1. K3EDTA results in greater RBC shrinkage;2. K3EDTA produces a larger increase in cell volume on standing;3. K3EDTA is a liquid additive and will result in the dilution of the specimen
56
Q

What type of additive is used for routine coagulation studies?

57
Q

What is the typical concentration of citrate used in a citrate additive collection tube?

A

3.2% buffered sodium citrate

58
Q

What type of additive is used for glucose determination on plasma?

59
Q

Describe a red-stopper tube.

A

contains no anticoagulant or preservative

60
Q

What collection tube color is used for serum or clotted whole blood?

A

red-stopper tube

61
Q

How soon after venipuncture must serum be separated from cells?

A

45 - 60 minutes

62
Q

What does a blue-stopper tube contain?

A

sodium citrate

63
Q

What color stopper does a sodium citrate additive tube have?

A

blue-stopper tube

64
Q

What color tube contains sodium fluoride?

A

gray-stopper tube

65
Q

What color stopper for a collection tube contains sodium heparin or lithium heparin?

A

green-stopper tube

66
Q

What color stopper indicates the additive acid citrate dextrose (ACD)?

A

yellow-stopper tube

67
Q

What color stopper indicates the additive EDTA for trace metal studies?

A

royal blue-stopper tube

68
Q

List the major patient identifiers of which you must have two on a requisition form.

A
  1. Name
  2. DOB or age
  3. MRN
69
Q

How long do blood and blood product records have to be stored?

Study Materials HCLD (10 decks)

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